Smart return pad sensing through modulation of near field communication and contact quality monitoring signals

ABSTRACT

Aspects of the present disclosure are presented for systems and methods for identifying characteristics of a return pad in a monopolar electrosurgical system using contact quality monitoring (CQM) and near field communication (NFC) signals. In some aspects, resistance or impedance materials are sensed that may help identify what kind of return pad is being used, including what is the structure of the pad. In some aspects, NFC signals are used to identify characteristics of the return pad. In some aspects, the grounding or return pad may include two separate materials that form an interconnecting or interwoven mesh and both act as non-active electrodes when both contact the patient. A non-zero impedance may separate conductive lines connecting the two separate materials that may be analyzed to obtain a defining signature about that is linked to structural characteristics about the return pad.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 62/826,584, titled MODULARSURGICAL PLATFORM ELECTRICAL ARCHITECTURE, filed Mar. 29, 2019, thedisclosure of which is herein incorporated by reference in its entirety.

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 62/826,587, titled MODULARENERGY SYSTEM CONNECTIVITY, filed Mar. 29, 2019, the disclosure of whichis herein incorporated by reference in its entirety.

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 62/826,588, titled MODULARENERGY SYSTEM INSTRUMENT COMMUNICATION TECHNIQUES, filed Mar. 29, 2019,the disclosure of which is herein incorporated by reference in itsentirety.

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 62/826,592, titled MODULARENERGY DELIVERY SYSTEM, filed Mar. 29, 2019, the disclosure of which isherein incorporated by reference in its entirety.

The present application claims priority under 35 U.S.C. § 119(e) to U.S.Provisional Patent Application Ser. No. 62/728,480, titled MODULARENERGY SYSTEM AND USER INTERFACE, filed Sep. 7, 2018, the disclosure ofwhich is herein incorporated by reference in its entirety.

BACKGROUND

The present disclosure relates to various surgical systems, includingmodular electrosurgical and/or ultrasonic surgical systems. Operatingrooms (ORs) are in need of streamlined capital solutions because ORs area tangled web of cords, devices, and people due to the number ofdifferent devices that are needed to complete each surgical procedure.This is a reality of every OR in every market throughout the globe.Capital equipment is a major offender in creating clutter within ORsbecause most capital equipment performs one task or job, and each typeof capital equipment requires unique techniques or methods to use andhas a unique user interface. Accordingly, there are unmet consumer needsfor capital equipment and other surgical technology to be consolidatedin order to decrease the equipment footprint within the OR, streamlinethe equipment's interfaces, and improve surgical staff efficiency duringa surgical procedure by reducing the number of devices that surgicalstaff members need to interact with.

SUMMARY

A grounding pad for use in a monopolar surgical system, comprising: afirst non-active electrode; a second non-active electrode; a firstconductive line electrically coupled to the first non-active electrode;a second conductive line electrically coupled to the second non-activeelectrode; and a non-zero impedance separating the first conductive linefrom the second conductive line; wherein the non-zero impedance providesan impedance measurement that provides defining information about whattype of pad is the grounding pad.

A method for identifying a grounding pad, the grounding pad comprising afirst non-active electrode and a second non-active electrode, the methodcomprising: transmitting, by a control circuit, a signal to both thefirst non-active electrode and the second non-active electrode;generating, by a non-zero impedance coupled to both the first non-activeelectrode and the second non-active electrode, an impedance measurementin response to the transmitted signal; and transmitting the impedance bya transformer using a modulated signal.

A monopolar surgical system, comprising: a generator; a monopolarsurgical instrument comprising an electrode configured to deliverelectrosurgical energy to a patient; a grounding pad comprising: a firstnon-active electrode; a second non-active electrode; a first conductiveline electrically coupled to the first non-active electrode; a secondconductive line electrically coupled to the second non-active electrode;a non-zero impedance separating the first conductive line from thesecond conductive line; wherein the non-zero impedance provides animpedance measurement that provides defining information about what typeof pad is the grounding pad; and a contact quality monitoring deviceconfigured to perform contact quality monitoring on the grounding padand also receive the impedance measurement to identify what type of padis the grounding pad.

FIGURES

The various aspects described herein, both as to organization andmethods of operation, together with further objects and advantagesthereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a block diagram of a computer-implemented interactive surgicalsystem, in accordance with at least one aspect of the presentdisclosure.

FIG. 2 is a surgical system being used to perform a surgical procedurein an operating room, in accordance with at least one aspect of thepresent disclosure.

FIG. 3 is a surgical hub paired with a visualization system, a roboticsystem, and an intelligent instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 4 is a partial perspective view of a surgical hub enclosure, and ofa combo generator module slidably receivable in a drawer of the surgicalhub enclosure, in accordance with at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of a combo generator module with bipolar,ultrasonic, and monopolar contacts and a smoke evacuation component, inaccordance with at least one aspect of the present disclosure.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing configured to receivea plurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 7 illustrates a vertical modular housing configured to receive aplurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 8 illustrates a surgical data network comprising a modularcommunication hub configured to connect modular devices located in oneor more operating theaters of a healthcare facility, or any room in ahealthcare facility specially equipped for surgical operations, to thecloud, in accordance with at least one aspect of the present disclosure.

FIG. 9 illustrates a computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure.

FIG. 10 illustrates a surgical hub comprising a plurality of modulescoupled to the modular control tower, in accordance with at least oneaspect of the present disclosure.

FIG. 11 illustrates one aspect of a Universal Serial Bus (USB) networkhub device, in accordance with at least one aspect of the presentdisclosure.

FIG. 12 illustrates a logic diagram of a control system of a surgicalinstrument or tool, in accordance with at least one aspect of thepresent disclosure.

FIG. 13 illustrates a control circuit configured to control aspects ofthe surgical instrument or tool, in accordance with at least one aspectof the present disclosure.

FIG. 14 illustrates a combinational logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 15 illustrates a sequential logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions, inaccordance with at least one aspect of the present disclosure.

FIG. 17 is a schematic diagram of a robotic surgical instrumentconfigured to operate a surgical tool described herein, in accordancewith at least one aspect of the present disclosure.

FIG. 18 illustrates a block diagram of a surgical instrument programmedto control the distal translation of a displacement member, inaccordance with at least one aspect of the present disclosure.

FIG. 19 is a schematic diagram of a surgical instrument configured tocontrol various functions, in accordance with at least one aspect of thepresent disclosure.

FIG. 20 is a system configured to execute adaptive ultrasonic bladecontrol algorithms in a surgical data network comprising a modularcommunication hub, in accordance with at least one aspect of the presentdisclosure.

FIG. 21 illustrates an example of a generator, in accordance with atleast one aspect of the present disclosure.

FIG. 22 is a surgical system comprising a generator and various surgicalinstruments usable therewith, in accordance with at least one aspect ofthe present disclosure.

FIG. 23 is a diagram of a situationally aware surgical system, inaccordance with at least one aspect of the present disclosure.

FIG. 24 is a diagram of various modules and other components that arecombinable to customize modular energy systems, in accordance with atleast one aspect of the present disclosure.

FIG. 25A is a first illustrative modular energy system configurationincluding a header module and a display screen that renders a graphicaluser interface (GUI) for relaying information regarding modulesconnected to the header module, in accordance with at least one aspectof the present disclosure.

FIG. 25B is the modular energy system shown in FIG. 25A mounted to acart, in accordance with at least one aspect of the present disclosure.

FIG. 26A is a second illustrative modular energy system configurationincluding a header module, a display screen, an energy module, and anexpanded energy module connected together and mounted to a cart, inaccordance with at least one aspect of the present disclosure.

FIG. 26B is a third illustrative modular energy system configurationthat is similar to the second configuration shown in FIG. 25A, exceptthat the header module lacks a display screen, in accordance with atleast one aspect of the present disclosure.

FIG. 27 is a fourth illustrative modular energy system configurationincluding a header module, a display screen, an energy module, aeexpanded energy module, and a technology module connected together andmounted to a cart, in accordance with at least one aspect of the presentdisclosure.

FIG. 28 is a fifth illustrative modular energy system configurationincluding a header module, a display screen, an energy module, anexpanded energy module, a technology module, and a visualization moduleconnected together and mounted to a cart, in accordance with at leastone aspect of the present disclosure.

FIG. 29 is a diagram of a modular energy system including communicablyconnectable surgical platforms, in accordance with at least one aspectof the present disclosure.

FIG. 30 is a perspective view of a header module of a modular energysystem including a user interface, in accordance with at least oneaspect of the present disclosure.

FIG. 31 is a block diagram of a stand-alone hub configuration of amodular energy system, in accordance with at least one aspect of thepresent disclosure.

FIG. 32 is a block diagram of a hub configuration of a modular energysystem integrated with a surgical control system, in accordance with atleast one aspect of the present disclosure.

FIG. 33 is a block diagram of a user interface module coupled to acommunications module of a modular energy system, in accordance with atleast one aspect of the present disclosure.

FIG. 34 is a block diagram of an energy module of a modular energysystem, in accordance with at least one aspect of the presentdisclosure.

FIGS. 35A and 35B illustrate a block diagram of an energy module coupledto a header module of a modular energy system, in accordance with atleast one aspect of the present disclosure.

FIGS. 36A and 36B illustrate a block diagram of a header/user interface(UI) module of a modular energy system for a hub, such as the headermodule depicted in FIG. 33, in accordance with at least one aspect ofthe present disclosure.

FIG. 37 is a block diagram of an energy module for a hub, such as theenergy module depicted in FIGS. 31-36B, in accordance with at least oneaspect of the present disclosure.

FIG. 38 shows an example circuit diagram illustrating several featuresabout a CQM controller design for how contact quality monitoring may beused to identify a return pad, in accordance with at least one aspect ofthe present disclosure.

FIG. 39 shows an example design layout of a return pad configured tofacilitate its identification using a pre-configured non-zero impedance,in accordance with at least one aspect of the present disclosure.

FIG. 40 shows a block diagram with structures similar to FIG. 38 thatalso include means for identifying the return pad using NFC signals, inaccordance with at least one aspect of the present disclosure.

FIG. 41 an example of how two signals may be combined to be processed bythe CQM controller, in accordance with at least one aspect of thepresent disclosure.

FIG. 42 provides an example designation of types of return pads that maybe categorized based on different impedance measurements, in accordancewith at least one aspect of the present disclosure.

FIG. 43 shows an example time series of a message channel used fortime-domain multiplexing the different types of signals between theenergy generator and the return pad, in accordance with at least oneaspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications filed concurrently herewith, the disclosure of each ofwhich is herein incorporated by reference in its entirety:

-   -   U.S. Patent Application Docket No. END9067USNP1/180679-1M,        titled METHOD FOR CONSTRUCTING AND USING A MODULAR SURGICAL        ENERGY SYSTEM WITH MULTIPLE DEVICES;    -   U.S. Patent Application Docket No. END9069USNP1/180681-1M,        titled METHOD FOR ENERGY DISTRIBUTION IN A SURGICAL MODULAR        ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9069USNP2/180681-2, titled        SURGICAL MODULAR ENERGY SYSTEM WITH A SEGMENTED BACKPLANE;    -   U.S. Patent Application Docket No. END9069USNP3/180681-3, titled        SURGICAL MODULAR ENERGY SYSTEM WITH FOOTER MODULE;    -   U.S. Patent Application Docket No. END9069USNP4/180681-4, titled        POWER AND COMMUNICATION MITIGATION ARRANGEMENT FOR MODULAR        SURGICAL ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9069USNP5/180681-5, titled        MODULAR SURGICAL ENERGY SYSTEM WITH MODULE POSITIONAL AWARENESS        SENSING WITH VOLTAGE DETECTION;    -   U.S. Patent Application Docket No. END9069USNP6/180681-6, titled        MODULAR SURGICAL ENERGY SYSTEM WITH MODULE POSITIONAL AWARENESS        SENSING WITH TIME COUNTER;    -   U.S. Patent Application Docket No. END9069USNP7/180681-7, titled        MODULAR SURGICAL ENERGY SYSTEM WITH MODULE POSITIONAL AWARENESS        WITH DIGITAL LOGIC;    -   U.S. Patent Application Docket No. END9068USNP1/180680-1M,        titled METHOD FOR CONTROLLING AN ENERGY MODULE OUTPUT;    -   U.S. Patent Application Docket No. END9068USNP2/180680-2, titled        ENERGY MODULE FOR DRIVING MULTIPLE ENERGY MODALITIES;    -   U.S. Patent Application Docket No. END9068USNP3/180680-3, titled        GROUNDING ARRANGEMENT OF ENERGY MODULES;    -   U.S. Patent Application Docket No. END9068USNP4/180680-4, titled        BACKPLANE CONNECTOR DESIGN TO CONNECT STACKED ENERGY MODULES;    -   U.S. Patent Application Docket No. END9068USNP5/180680-5, titled        ENERGY MODULE FOR DRIVING MULTIPLE ENERGY MODALITIES THROUGH A        PORT;    -   U.S. Patent Application Docket No. END9068USNP6/180680-6 titled        SURGICAL INSTRUMENT UTILIZING DRIVE SIGNAL TO POWER SECONDARY        FUNCTION;    -   U.S. Patent Application Docket No. END9038USNP1/180529-1M,        titled METHOD FOR CONTROLLING A MODULAR ENERGY SYSTEM USER        INTERFACE;    -   U.S. Patent Application Docket No. END9038USNP2/180529-2, titled        PASSIVE HEADER MODULE FOR A MODULAR ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9038USNP3/180529-3, titled        CONSOLIDATED USER INTERFACE FOR MODULAR ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9038USNP4/180529-4, titled        AUDIO TONE CONSTRUCTION FOR AN ENERGY MODULE OF A MODULAR ENERGY        SYSTEM;    -   U.S. Patent Application Docket No. END9038USNP5/180529-5, titled        ADAPTABLY CONNECTABLE AND REASSIGNABLE SYSTEM ACCESSORIES FOR        MODULAR ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9070USNP1/180682-1M,        titled METHOD FOR COMMUNICATING BETWEEN MODULES AND DEVICES IN A        MODULAR SURGICAL SYSTEM;    -   U.S. Patent Application Docket No. END9070USNP2/180682-2, titled        FLEXIBLE HAND-SWITCH CIRCUIT;    -   U.S. Patent Application Docket No. END9070USNP3/180682-3, titled        FIRST AND SECOND COMMUNICATION PROTOCOL ARRANGEMENT FOR DRIVING        PRIMARY AND SECONDARY DEVICES THROUGH A SINGLE PORT;    -   U.S. Patent Application Docket No. END9070USNP4/180682-4, titled        FLEXIBLE NEUTRAL ELECTRODE;    -   U.S. Patent Application Docket No. END9070USNP5/180682-5, titled        SMART RETURN PAD SENSING THROUGH MODULATION OF NEAR FIELD        COMMUNICATION AND CONTACT QUALITY MONITORING SIGNALS;    -   U.S. Patent Application Docket No. END9070USNP6/180682-6, titled        AUTOMATIC ULTRASONIC ENERGY ACTIVATION CIRCUIT DESIGN FOR        MODULAR SURGICAL SYSTEMS;    -   U.S. Patent Application Docket No. END9070USNP7/180682-7, titled        COORDINATED ENERGY OUTPUTS OF SEPARATE BUT CONNECTED MODULES;    -   U.S. Patent Application Docket No. END9070USNP8/180682-8, titled        MANAGING SIMULTANEOUS MONOPOLAR OUTPUTS USING DUTY CYCLE AND        SYNCHRONIZATION;    -   U.S. Patent Application Docket No. END9070USNP9/180682-9, titled        PORT PRESENCE DETECTION SYSTEM FOR MODULAR ENERGY SYSTEM;    -   U.S. Patent Application Docket No. END9070USNP10/180682-10,        titled INSTRUMENT TRACKING ARRANGEMENT BASED ON REAL TIME CLOCK        INFORMATION;    -   U.S. Patent Application Docket No. END9070USNP11/180682-11,        titled REGIONAL LOCATION TRACKING OF COMPONENTS OF A MODULAR        ENERGY SYSTEM;    -   U.S. Design Patent Application Docket No. END9212USDP1/190370D,        titled ENERGY MODULE;    -   U.S. Design Patent Application Docket No. END9213USDP1/190371D,        titled ENERGY MODULE MONOPOLAR PORT WITH FOURTH SOCKET AMONG        THREE OTHER SOCKETS;    -   U.S. Design Patent Application Docket No. END9214USDP1/190372D,        titled BACKPLANE CONNECTOR FOR ENERGY MODULE; and    -   U.S. Design Patent Application Docket No. END9215USDP1/190373D,        titled ALERT SCREEN FOR ENERGY MODULE.

Before explaining various aspects of surgical devices and generators indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects and/or examples.

Various aspects are directed to improved ultrasonic surgical devices,electrosurgical devices and generators for use therewith. Aspects of theultrasonic surgical devices can be configured for transecting and/orcoagulating tissue during surgical procedures, for example. Aspects ofthe electrosurgical devices can be configured for transecting,coagulating, scaling, welding and/or desiccating tissue during surgicalprocedures, for example.

Surgical System Hardware

Referring to FIG. 1, a computer-implemented interactive surgical system100 includes one or more surgical systems 102 and a cloud-based system(e.g., the cloud 104 that may include a remote server 113 coupled to astorage device 105). Each surgical system 102 includes at least onesurgical hub 106 in communication with the cloud 104 that may include aremote server 113. In one example, as illustrated in FIG. 1, thesurgical system 102 includes a visualization system 108, a roboticsystem 110, and a handheld intelligent surgical instrument 112, whichare configured to communicate with one another and/or the hub 106. Insome aspects, a surgical system 102 may include an M number of hubs 106,an N number of visualization systems 108, an O number of robotic systems110, and a P number of handheld intelligent surgical instruments 112,where M, N, O, and P are integers greater than or equal to one.

FIG. 2 depicts an example of a surgical system 102 being used to performa surgical procedure on a patient who is lying down on an operatingtable 114 in a surgical operating room 116. A robotic system 110 is usedin the surgical procedure as a part of the surgical system 102. Therobotic system 110 includes a surgeon's console 118, a patient side cart120 (surgical robot), and a surgical robotic hub 122. The patient sidecart 120 can manipulate at least one removably coupled surgical tool 117through a minimally invasive incision in the body of the patient whilethe surgeon views the surgical site through the surgeon's console 118.An image of the surgical site can be obtained by a medical imagingdevice 124, which can be manipulated by the patient side cart 120 toorient the imaging device 124. The robotic hub 122 can be used toprocess the images of the surgical site for subsequent display to thesurgeon through the surgeon's console 118.

Other types of robotic systems can be readily adapted for use with thesurgical system 102. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,339,titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud 104, and are suitable for use with the present disclosure, aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,340,titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

In various aspects, the imaging device 124 includes at least one imagesensor and one or more optical components. Suitable image sensorsinclude, but are not limited to, Charge-Coupled Device (CCD) sensors andComplementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 124 may include one or moreillumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is that portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that are from about 380 nm to about750 nm.

The invisible spectrum (i.e., the non-luminous spectrum) is that portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

In one aspect, the imaging device employs multi-spectrum monitoring todiscriminate topography and underlying structures. A multi-spectralimage is one that captures image data within specific wavelength rangesacross the electromagnetic spectrum. The wavelengths may be separated byfilters or by the use of instruments that are sensitive to particularwavelengths, including light from frequencies beyond the visible lightrange, e.g., IR and ultraviolet. Spectral imaging can allow extractionof additional information the human eye fails to capture with itsreceptors for red, green, and blue. The use of multi-spectral imaging isdescribed in greater detail under the heading “Advanced ImagingAcquisition Module” in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety. Multi-spectrum monitoring can be a useful tool in relocating asurgical field after a surgical task is completed to perform one or moreof the previously described tests on the treated tissue.

It is axiomatic that strict sterilization of the operating room andsurgical equipment is required during any surgery. The strict hygieneand sterilization conditions required in a “surgical theater,” i.e., anoperating or treatment room, necessitate the highest possible sterilityof all medical devices and equipment. Part of that sterilization processis the need to sterilize anything that comes in contact with the patientor penetrates the sterile field, including the imaging device 124 andits attachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area. In various aspects, the visualization system108 includes one or more imaging sensors, one or more image-processingunits, one or more storage arrays, and one or more displays that arestrategically arranged with respect to the sterile field, as illustratedin FIG. 2. In one aspect, the visualization system 108 includes aninterface for HL7, PACS, and EMR. Various components of thevisualization system 108 are described under the heading “AdvancedImaging Acquisition Module” in U.S. Provisional Patent Application Ser.No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28,2017, the disclosure of which is herein incorporated by reference in itsentirety.

As illustrated in FIG. 2, a primary display 119 is positioned in thesterile field to be visible to an operator at the operating table 114.In addition, a visualization tower 111 is positioned outside the sterilefield. The visualization tower 111 includes a first non-sterile display107 and a second non-sterile display 109, which face away from eachother. The visualization system 108, guided by the hub 106, isconfigured to utilize the displays 107, 109, and 119 to coordinateinformation flow to operators inside and outside the sterile field. Forexample, the hub 106 may cause the visualization system 108 to display asnapshot of a surgical site, as recorded by an imaging device 124, on anon-sterile display 107 or 109, while maintaining a live feed of thesurgical site on the primary display 119. The snapshot on thenon-sterile display 107 or 109 can permit a non-sterile operator toperform a diagnostic step relevant to the surgical procedure, forexample.

In one aspect, the hub 106 is also configured to route a diagnosticinput or feedback entered by a non-sterile operator at the visualizationtower 111 to the primary display 119 within the sterile field, where itcan be viewed by a sterile operator at the operating table. In oneexample, the input can be in the form of a modification to the snapshotdisplayed on the non-sterile display 107 or 109, which can be routed tothe primary display 119 by the hub 106.

Referring to FIG. 2, a surgical instrument 112 is being used in thesurgical procedure as part of the surgical system 102. The hub 106 isalso configured to coordinate information flow to a display of thesurgical instrument 112. For example, in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety. A diagnostic input or feedback entered by anon-sterile operator at the visualization tower 111 can be routed by thehub 106 to the surgical instrument display 115 within the sterile field,where it can be viewed by the operator of the surgical instrument 112.Example surgical instruments that are suitable for use with the surgicalsystem 102 are described under the heading SURGICAL INSTRUMENT HARDWAREand in U.S. Provisional Patent Application Ser. No. 62/611,341, titledINTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure ofwhich is herein incorporated by reference in its entirety, for example.

Referring now to FIG. 3, a hub 106 is depicted in communication with avisualization system 108, a robotic system 110, and a handheldintelligent surgical instrument 112. The hub 106 includes a hub display135, an imaging module 138, a generator module 140, a communicationmodule 130, a processor module 132, and a storage array 134. In certainaspects, as illustrated in FIG. 3, the hub 106 further includes a smokeevacuation module 126 and/or a suction/irrigation module 128.

During a surgical procedure, energy application to tissue, for sealingand/or cutting, is generally associated with smoke evacuation, suctionof excess fluid, and/or irrigation of the tissue. Fluid, power, and/ordata lines from different sources are often entangled during thesurgical procedure. Valuable time can be lost addressing this issueduring a surgical procedure. Detangling the lines may necessitatedisconnecting the lines from their respective modules, which may requireresetting the modules. The hub modular enclosure 136 offers a unifiedenvironment for managing the power, data, and fluid lines, which reducesthe frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in asurgical procedure that involves energy application to tissue at asurgical site. The surgical hub includes a hub enclosure and a combogenerator module slidably receivable in a docking station of the hubenclosure. The docking station includes data and power contacts. Thecombo generator module includes two or more of an ultrasonic energygenerator component, a bipolar RF energy generator component, and amonopolar RF energy generator component that are housed in a singleunit. In one aspect, the combo generator module also includes a smokeevacuation component, at least one energy delivery cable for connectingthe combo generator module to a surgical instrument, at least one smokeevacuation component configured to evacuate smoke, fluid, and/orparticulates generated by the application of therapeutic energy to thetissue, and a fluid line extending from the remote surgical site to thesmoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluidline extends from the remote surgical site to a suction and irrigationmodule slidably received in the hub enclosure. In one aspect, the hubenclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than oneenergy type to the tissue. One energy type may be more beneficial forcutting the tissue, while another different energy type may be morebeneficial for sealing the tissue. For example, a bipolar generator canbe used to seal the tissue while an ultrasonic generator can be used tocut the sealed tissue. Aspects of the present disclosure present asolution where a hub modular enclosure 136 is configured to accommodatedifferent generators, and facilitate an interactive communicationtherebetween. One of the advantages of the hub modular enclosure 136 isenabling the quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical enclosurefor use in a surgical procedure that involves energy application totissue. The modular surgical enclosure includes a first energy-generatormodule, configured to generate a first energy for application to thetissue, and a first docking station comprising a first docking port thatincludes first data and power contacts, wherein the firstenergy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts.

Further to the above, the modular surgical enclosure also includes asecond energy-generator module configured to generate a second energy,different than the first energy, for application to the tissue, and asecond docking station comprising a second docking port that includessecond data and power contacts, wherein the second energy-generatormodule is slidably movable into an electrical engagement with the powerand data contacts, and wherein the second energy-generator module isslidably movable out of the electrical engagement with the second powerand data contacts.

In addition, the modular surgical enclosure also includes acommunication bus between the first docking port and the second dockingport, configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.

Referring to FIGS. 3-7, aspects of the present disclosure are presentedfor a hub modular enclosure 136 that allows the modular integration of agenerator module 140, a smoke evacuation module 126, and asuction/irrigation module 128. The hub modular enclosure 136 furtherfacilitates interactive communication between the modules 140, 126, 128.As illustrated in FIG. 5, the generator module 140 can be a generatormodule with integrated monopolar, bipolar, and ultrasonic componentssupported in a single housing unit 139 slidably insertable into the hubmodular enclosure 136. As illustrated in FIG. 5, the generator module140 can be configured to connect to a monopolar device 146, a bipolardevice 147, and an ultrasonic device 148. Alternatively, the generatormodule 140 may comprise a series of monopolar, bipolar, and/orultrasonic generator modules that interact through the hub modularenclosure 136. The hub modular enclosure 136 can be configured tofacilitate the insertion of multiple generators and interactivecommunication between the generators docked into the hub modularenclosure 136 so that the generators would act as a single generator.

In one aspect, the hub modular enclosure 136 comprises a modular powerand communication backplane 149 with external and wireless communicationheaders to enable the removable attachment of the modules 140, 126, 128and interactive communication therebetween.

In one aspect, the hub modular enclosure 136 includes docking stations,or drawers, 151, herein also referred to as drawers, which areconfigured to slidably receive the modules 140, 126, 128. FIG. 4illustrates a partial perspective view of a surgical hub enclosure 136,and a combo generator module 145 slidably receivable in a dockingstation 151 of the surgical hub enclosure 136. A docking port 152 withpower and data contacts on a rear side of the combo generator module 145is configured to engage a corresponding docking port 150 with power anddata contacts of a corresponding docking station 151 of the hub modularenclosure 136 as the combo generator module 145 is slid into positionwithin the corresponding docking station 151 of the hub module enclosure136. In one aspect, the combo generator module 145 includes a bipolar,ultrasonic, and monopolar module and a smoke evacuation moduleintegrated together into a single housing unit 139, as illustrated inFIG. 5.

In various aspects, the smoke evacuation module 126 includes a fluidline 154 that conveys captured/collected smoke and/or fluid away from asurgical site and to, for example, the smoke evacuation module 126.Vacuum suction originating from the smoke evacuation module 126 can drawthe smoke into an opening of a utility conduit at the surgical site. Theutility conduit, coupled to the fluid line, can be in the form of aflexible tube terminating at the smoke evacuation module 126. Theutility conduit and the fluid line define a fluid path extending towardthe smoke evacuation module 126 that is received in the hub enclosure136.

In various aspects, the suction/irrigation module 128 is coupled to asurgical tool comprising an aspiration fluid line and a suction fluidline. In one example, the aspiration and suction fluid lines are in theform of flexible tubes extending from the surgical site toward thesuction/irrigation module 128. One or more drive systems can beconfigured to cause irrigation and aspiration of fluids to and from thesurgical site.

In one aspect, the surgical tool includes a shaft having an end effectorat a distal end thereof and at least one energy treatment associatedwith the end effector, an aspiration tube, and an irrigation tube. Theaspiration tube can have an inlet port at a distal end thereof and theaspiration tube extends through the shaft. Similarly, an irrigation tubecan extend through the shaft and can have an inlet port in proximity tothe energy deliver implement. The energy deliver implement is configuredto deliver ultrasonic and/or RF energy to the surgical site and iscoupled to the generator module 140 by a cable extending initiallythrough the shaft.

The irrigation tube can be in fluid communication with a fluid source,and the aspiration tube can be in fluid communication with a vacuumsource. The fluid source and/or the vacuum source can be housed in thesuction/irrigation module 128. In one example, the fluid source and/orthe vacuum source can be housed in the hub enclosure 136 separately fromthe suction/irrigation module 128. In such example, a fluid interfacecan be configured to connect the suction/irrigation module 128 to thefluid source and/or the vacuum source.

In one aspect, the modules 140, 126, 128 and/or their correspondingdocking stations on the hub modular enclosure 136 may include alignmentfeatures that are configured to align the docking ports of the modulesinto engagement with their counterparts in the docking stations of thehub modular enclosure 136. For example, as illustrated in FIG. 4, thecombo generator module 145 includes side brackets 155 that areconfigured to slidably engage with corresponding brackets 156 of thecorresponding docking station 151 of the hub modular enclosure 136. Thebrackets cooperate to guide the docking port contacts of the combogenerator module 145 into an electrical engagement with the docking portcontacts of the hub modular enclosure 136.

In some aspects, the drawers 151 of the hub modular enclosure 136 arethe same, or substantially the same size, and the modules are adjustedin size to be received in the drawers 151. For example, the sidebrackets 155 and/or 156 can be larger or smaller depending on the sizeof the module. In other aspects, the drawers 151 are different in sizeand are each designed to accommodate a particular module.

Furthermore, the contacts of a particular module can be keyed forengagement with the contacts of a particular drawer to avoid inserting amodule into a drawer with mismatching contacts.

As illustrated in FIG. 4, the docking port 150 of one drawer 151 can becoupled to the docking port 150 of another drawer 151 through acommunications link 157 to facilitate an interactive communicationbetween the modules housed in the hub modular enclosure 136. The dockingports 150 of the hub modular enclosure 136 may alternatively, oradditionally, facilitate a wireless interactive communication betweenthe modules housed in the hub modular enclosure 136. Any suitablewireless communication can be employed, such as for example AirTitan-Bluetooth.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing 160 configured toreceive a plurality of modules of a surgical hub 206. The lateralmodular housing 160 is configured to laterally receive and interconnectthe modules 161. The modules 161 are slidably inserted into dockingstations 162 of lateral modular housing 160, which includes a backplanefor interconnecting the modules 161. As illustrated in FIG. 6, themodules 161 are arranged laterally in the lateral modular housing 160.Alternatively, the modules 161 may be arranged vertically in a lateralmodular housing.

FIG. 7 illustrates a vertical modular housing 164 configured to receivea plurality of modules 165 of the surgical hub 106. The modules 165 areslidably inserted into docking stations, or drawers, 167 of verticalmodular housing 164, which includes a backplane for interconnecting themodules 165. Although the drawers 167 of the vertical modular housing164 are arranged vertically, in certain instances, a vertical modularhousing 164 may include drawers that are arranged laterally.Furthermore, the modules 165 may interact with one another through thedocking ports of the vertical modular housing 164. In the example ofFIG. 7, a display 177 is provided for displaying data relevant to theoperation of the modules 165. In addition, the vertical modular housing164 includes a master module 178 housing a plurality of sub-modules thatare slidably received in the master module 178.

In various aspects, the imaging module 138 comprises an integrated videoprocessor and a modular light source and is adapted for use with variousimaging devices. In one aspect, the imaging device is comprised of amodular housing that can be assembled with a light source module and acamera module. The housing can be a disposable housing. In at least oneexample, the disposable housing is removably coupled to a reusablecontroller, a light source module, and a camera module. The light sourcemodule and/or the camera module can be selectively chosen depending onthe type of surgical procedure. In one aspect, the camera modulecomprises a CCD sensor. In another aspect, the camera module comprises aCMOS sensor. In another aspect, the camera module is configured forscanned beam imaging. Likewise, the light source module can beconfigured to deliver a white light or a different light, depending onthe surgical procedure.

During a surgical procedure, removing a surgical device from thesurgical field and replacing it with another surgical device thatincludes a different camera or a different light source can beinefficient. Temporarily losing sight of the surgical field may lead toundesirable consequences. The module imaging device of the presentdisclosure is configured to permit the replacement of a light sourcemodule or a camera module midstream during a surgical procedure, withouthaving to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing thatincludes a plurality of channels. A first channel is configured toslidably receive the camera module, which can be configured for asnap-fit engagement with the first channel. A second channel isconfigured to slidably receive the light source module, which can beconfigured for a snap-fit engagement with the second channel. In anotherexample, the camera module and/or the light source module can be rotatedinto a final position within their respective channels. A threadedengagement can be employed in lieu of the snap-fit engagement.

In various examples, multiple imaging devices are placed at differentpositions in the surgical field to provide multiple views. The imagingmodule 138 can be configured to switch between the imaging devices toprovide an optimal view. In various aspects, the imaging module 138 canbe configured to integrate the images from the different imaging device.

Various image processors and imaging devices suitable for use with thepresent disclosure are described in U.S. Pat. No. 7,995,045, titledCOMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9,2011, which is herein incorporated by reference in its entirety. Inaddition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVALAPPARATUS AND METHOD, which issued on Jul. 19, 2011, which is hereinincorporated by reference in its entirety, describes various systems forremoving motion artifacts from image data. Such systems can beintegrated with the imaging module 138. Furthermore, U.S. PatentApplication Publication No. 2011/0306840, titled CONTROLLABLE MAGNETICSOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15,2011, and U.S. Patent Application Publication No. 2014/0243597, titledSYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, whichpublished on Aug. 28, 2014, each of which is herein incorporated byreference in its entirety.

FIG. 8 illustrates a surgical data network 201 comprising a modularcommunication hub 203 configured to connect modular devices located inone or more operating theaters of a healthcare facility, or any room ina healthcare facility specially equipped for surgical operations, to acloud-based system (e.g., the cloud 204 that may include a remote server213 coupled to a storage device 205). In one aspect, the modularcommunication hub 203 comprises a network hub 207 and/or a networkswitch 209 in communication with a network router. The modularcommunication hub 203 also can be coupled to a local computer system 210to provide local computer processing and data manipulation. The surgicaldata network 201 may be configured as passive, intelligent, orswitching. A passive surgical data network serves as a conduit for thedata, enabling it to go from one device (or segment) to another and tothe cloud computing resources. An intelligent surgical data networkincludes additional features to enable the traffic passing through thesurgical data network to be monitored and to configure each port in thenetwork hub 207 or network switch 209. An intelligent surgical datanetwork may be referred to as a manageable hub or switch. A switchinghub reads the destination address of each packet and then forwards thepacket to the correct port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 203. The network hub 207 and/or thenetwork switch 209 may be coupled to a network router 211 to connect thedevices 1 a-1 n to the cloud 204 or the local computer system 210. Dataassociated with the devices 1 a-1 n may be transferred to cloud-basedcomputers via the router for remote data processing and manipulation.Data associated with the devices 1 a-1 n may also be transferred to thelocal computer system 210 for local data processing and manipulation.Modular devices 2 a-2 m located in the same operating theater also maybe coupled to a network switch 209. The network switch 209 may becoupled to the network hub 207 and/or the network router 211 to connectto the devices 2 a-2 m to the cloud 204. Data associated with thedevices 2 a-2 n may be transferred to the cloud 204 via the networkrouter 211 for data processing and manipulation. Data associated withthe devices 2 a-2 m may also be transferred to the local computer system210 for local data processing and manipulation.

It will be appreciated that the surgical data network 201 may beexpanded by interconnecting multiple network hubs 207 and/or multiplenetwork switches 209 with multiple network routers 211. The modularcommunication hub 203 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 210 also may be contained in a modular control tower.The modular communication hub 203 is connected to a display 212 todisplay images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module 138 coupled to an endoscope, a generator module 140coupled to an energy-based surgical device, a smoke evacuation module126, a suction/irrigation module 128, a communication module 130, aprocessor module 132, a storage array 134, a surgical device coupled toa display, and/or a non-contact sensor module, among other modulardevices that may be connected to the modular communication hub 203 ofthe surgical data network 201.

In one aspect, the surgical data network 201 may comprise a combinationof network hub(s), network switch(es), and network router(s) connectingthe devices 1 a-1 n/2 a-2 m to the cloud. Any one of or all of thedevices 1 a-1 n/2 a-2 m coupled to the network hub or network switch maycollect data in real time and transfer the data to cloud computers fordata processing and manipulation. It will be appreciated that cloudcomputing relies on sharing computing resources rather than having localservers or personal devices to handle software applications. The word“cloud” may be used as a metaphor for “the Internet,” although the termis not limited as such. Accordingly, the term “cloud computing” may beused herein to refer to “a type of Internet-based computing,” wheredifferent services—such as servers, storage, and applications—aredelivered to the modular communication hub 203 and/or computer system210 located in the surgical theater (e.g., a fixed, mobile, temporary,or field operating room or space) and to devices connected to themodular communication hub 203 and/or computer system 210 through theInternet. The cloud infrastructure may be maintained by a cloud serviceprovider. In this context, the cloud service provider may be the entitythat coordinates the usage and control of the devices 1 a-1 n/2 a-2 mlocated in one or more operating theaters. The cloud computing servicescan perform a large number of calculations based on the data gathered bysmart surgical instruments, robots, and other computerized deviceslocated in the operating theater. The hub hardware enables multipledevices or connections to be connected to a computer that communicateswith the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network providesimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This includes localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloud 204or the local computer system 210 or both for data processing andmanipulation including image processing and manipulation. The data maybe analyzed to improve surgical procedure outcomes by determining iffurther treatment, such as the application of endoscopic intervention,emerging technologies, a targeted radiation, targeted intervention, andprecise robotics to tissue-specific sites and conditions, may bepursued. Such data analysis may further employ outcome analyticsprocessing, and using standardized approaches may provide beneficialfeedback to either confirm surgical treatments and the behavior of thesurgeon or suggest modifications to surgical treatments and the behaviorof the surgeon.

In one implementation, the operating theater devices 1 a-1 n may beconnected to the modular communication hub 203 over a wired channel or awireless channel depending on the configuration of the devices 1 a-1 nto a network hub. The network hub 207 may be implemented, in one aspect,as a local network broadcast device that works on the physical layer ofthe Open System Interconnection (OSI) model. The network hub providesconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 207 collects data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 207 does not store any media access control/Internet Protocol(MAC/IP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 207. The network hub 207has no routing tables or intelligence regarding where to sendinformation and broadcasts all network data across each connection andto a remote server 213 (FIG. 9) over the cloud 204. The network hub 207can detect basic network errors such as collisions, but having allinformation broadcast to multiple ports can be a security risk and causebottlenecks.

In another implementation, the operating theater devices 2 a-2 m may beconnected to a network switch 209 over a wired channel or a wirelesschannel. The network switch 209 works in the data link layer of the OSImodel. The network switch 209 is a multicast device for connecting thedevices 2 a-2 m located in the same operating theater to the network.The network switch 209 sends data in the form of frames to the networkrouter 211 and works in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 209. The networkswitch 209 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 207 and/or the network switch 209 are coupled to thenetwork router 211 for connection to the cloud 204. The network router211 works in the network layer of the OSI model. The network router 211creates a route for transmitting data packets received from the networkhub 207 and/or network switch 211 to cloud-based computer resources forfurther processing and manipulation of the data collected by any one ofor all the devices 1 a-1 n/2 a-2 m. The network router 211 may beemployed to connect two or more different networks located in differentlocations, such as, for example, different operating theaters of thesame healthcare facility or different networks located in differentoperating theaters of different healthcare facilities. The networkrouter 211 sends data in the form of packets to the cloud 204 and worksin full duplex mode. Multiple devices can send data at the same time.The network router 211 uses IP addresses to transfer data.

In one example, the network hub 207 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 207 may include wired or wireless capabilitiesto receive information over a wired channel or a wireless channel. Inone aspect, a wireless USB short-range, high-bandwidth wireless radiocommunication protocol may be employed for communication between thedevices 1 a-1 n and devices 2 a-2 m located in the operating theater.

In other examples, the operating theater devices 1 a-1 n/2 a-2 m maycommunicate to the modular communication hub 203 via Bluetooth wirelesstechnology standard for exchanging data over short distances (usingshort-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz)from fixed and mobile devices and building personal area networks(PANs). In other aspects, the operating theater devices 1 a-1 n/2 a-2 mmay communicate to the modular communication hub 203 via a number ofwireless or wired communication standards or protocols, including butnot limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family),IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivativesthereof, as well as any other wireless and wired protocols that aredesignated as 3G, 4G, 5G, and beyond. The computing module may include aplurality of communication modules. For instance, a first communicationmodule may be dedicated to shorter-range wireless communications such asWi-Fi and Bluetooth, and a second communication module may be dedicatedto longer-range wireless communications such as GPS, EDGE, GPRS, CDMA,WiMAX, LTE, Ev-DO, and others.

The modular communication hub 203 may serve as a central connection forone or all of the operating theater devices 1 a-1 n/2 a-2 m and handlesa data type known as frames. Frames carry the data generated by thedevices 1 a-1 n/2 a-2 m. When a frame is received by the modularcommunication hub 203, it is amplified and transmitted to the networkrouter 211, which transfers the data to the cloud computing resources byusing a number of wireless or wired communication standards orprotocols, as described herein.

The modular communication hub 203 can be used as a standalone device orbe connected to compatible network hubs and network switches to form alarger network. The modular communication hub 203 is generally easy toinstall, configure, and maintain, making it a good option for networkingthe operating theater devices 1 a-1 n/2 a-2 m.

FIG. 9 illustrates a computer-implemented interactive surgical system200. The computer-implemented interactive surgical system 200 is similarin many respects to the computer-implemented interactive surgical system100. For example, the computer-implemented interactive surgical system200 includes one or more surgical systems 202, which are similar in manyrespects to the surgical systems 102. Each surgical system 202 includesat least one surgical hub 206 in communication with a cloud 204 that mayinclude a remote server 213. In one aspect, the computer-implementedinteractive surgical system 200 comprises a modular control tower 236connected to multiple operating theater devices such as, for example,intelligent surgical instruments, robots, and other computerized deviceslocated in the operating theater. As shown in FIG. 10, the modularcontrol tower 236 comprises a modular communication hub 203 coupled to acomputer system 210. As illustrated in the example of FIG. 9, themodular control tower 236 is coupled to an imaging module 238 that iscoupled to an endoscope 239, a generator module 240 that is coupled toan energy device 241, a smoke evacuator module 226, a suction/irrigationmodule 228, a communication module 230, a processor module 232, astorage array 234, a smart device/instrument 235 optionally coupled to adisplay 237, and a non-contact sensor module 242. The operating theaterdevices are coupled to cloud computing resources and data storage viathe modular control tower 236. A robot hub 222 also may be connected tothe modular control tower 236 and to the cloud computing resources. Thedevices/instruments 235, visualization systems 208, among others, may becoupled to the modular control tower 236 via wired or wirelesscommunication standards or protocols, as described herein. The modularcontrol tower 236 may be coupled to a hub display 215 (e.g., monitor,screen) to display and overlay images received from the imaging module,device/instrument display, and/or other visualization systems 208. Thehub display also may display data received from devices connected to themodular control tower in conjunction with images and overlaid images.

FIG. 10 illustrates a surgical hub 206 comprising a plurality of modulescoupled to the modular control tower 236. The modular control tower 236comprises a modular communication hub 203, e.g., a network connectivitydevice, and a computer system 210 to provide local processing,visualization, and imaging, for example. As shown in FIG. 10, themodular communication hub 203 may be connected in a tiered configurationto expand the number of modules (e.g., devices) that may be connected tothe modular communication hub 203 and transfer data associated with themodules to the computer system 210, cloud computing resources, or both.As shown in FIG. 10, each of the network hubs/switches in the modularcommunication hub 203 includes three downstream ports and one upstreamport. The upstream network hub/switch is connected to a processor toprovide a communication connection to the cloud computing resources anda local display 217. Communication to the cloud 204 may be made eitherthrough a wired or a wireless communication channel.

The surgical hub 206 employs a non-contact sensor module 242 to measurethe dimensions of the operating theater and generate a map of thesurgical theater using either ultrasonic or laser-type non-contactmeasurement devices. An ultrasound-based non-contact sensor module scansthe operating theater by transmitting a burst of ultrasound andreceiving the echo when it bounces off the perimeter walls of anoperating theater as described under the heading “Surgical Hub SpatialAwareness Within an Operating Room” in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is herein incorporated by reference in itsentirety, in which the sensor module is configured to determine the sizeof the operating theater and to adjust Bluetooth-pairing distancelimits. A laser-based non-contact sensor module scans the operatingtheater by transmitting laser light pulses, receiving laser light pulsesthat bounce off the perimeter walls of the operating theater, andcomparing the phase of the transmitted pulse to the received pulse todetermine the size of the operating theater and to adjust Bluetoothpairing distance limits, for example.

The computer system 210 comprises a processor 244 and a networkinterface 245. The processor 244 is coupled to a communication module247, storage 248, memory 249, non-volatile memory 250, and input/outputinterface 251 via a system bus. The system bus can be any of severaltypes of bus structure(s) including the memory bus or memory controller,a peripheral bus or external bus, and/or a local bus using any varietyof available bus architectures including, but not limited to, 9-bit bus,Industrial Standard Architecture (ISA), Micro-Charmel Architecture(MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESALocal Bus (VLB), Peripheral Component Interconnect (PCI), USB, AdvancedGraphics Port (AGP), Personal Computer Memory Card InternationalAssociation bus (PCMCIA), Small Computer Systems Interface (SCSI), orany other proprietary bus.

The processor 244 may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In one aspect, the processor 244 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The system memory includes volatile memory and non-volatile memory. Thebasic input/output system (BIOS), containing the basic routines totransfer information between elements within the computer system, suchas during start-up, is stored in non-volatile memory. For example, thenon-volatile memory can include ROM, programmable ROM (PROM),electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatilememory includes random-access memory (RAM), which acts as external cachememory. Moreover, RAM is available in many forms such as SRAM, dynamicRAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and directRambus RAM (DRRAM).

The computer system 210 also includes removable/non-removable,volatile/non-volatile computer storage media, such as for example diskstorage. The disk storage includes, but is not limited to, devices likea magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zipdrive, LS-60 drive, flash memory card, or memory stick. In addition, thedisk storage can include storage media separately or in combination withother storage media including, but not limited to, an optical disc drivesuch as a compact disc ROM device (CD-ROM), compact disc recordabledrive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or adigital versatile disc ROM drive (DVD-ROM). To facilitate the connectionof the disk storage devices to the system bus, a removable ornon-removable interface may be employed.

It is to be appreciated that the computer system 210 includes softwarethat acts as an intermediary between users and the basic computerresources described in a suitable operating environment. Such softwareincludes an operating system. The operating system, which can be storedon the disk storage, acts to control and allocate resources of thecomputer system. System applications take advantage of the management ofresources by the operating system through program modules and programdata stored either in the system memory or on the disk storage. It is tobe appreciated that various components described herein can beimplemented with various operating systems or combinations of operatingsystems.

A user enters commands or information into the computer system 210through input device(s) coupled to the I/O interface 251. The inputdevices include, but are not limited to, a pointing device such as amouse, trackball, stylus, touch pad, keyboard, microphone, joystick,game pad, satellite dish, scanner, TV tuner card, digital camera,digital video camera, web camera, and the like. These and other inputdevices connect to the processor through the system bus via interfaceport(s). The interface port(s) include, for example, a serial port, aparallel port, a game port, and a USB. The output device(s) use some ofthe same types of ports as input device(s). Thus, for example, a USBport may be used to provide input to the computer system and to outputinformation from the computer system to an output device. An outputadapter is provided to illustrate that there are some output deviceslike monitors, displays, speakers, and printers, among other outputdevices that require special adapters. The output adapters include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), provide both input and output capabilities.

The computer system 210 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) is logically connected to the computer system througha network interface and then physically connected via a communicationconnection. The network interface encompasses communication networkssuch as local area networks (LANs) and wide area networks (WANs). LANtechnologies include Fiber Distributed Data Interface (FDDI), CopperDistributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE802.5 and the like. WAN technologies include, but are not limited to,point-to-point links, circuit-switching networks like IntegratedServices Digital Networks (ISDN) and variations thereon,packet-switching networks, and Digital Subscriber Lines (DSL).

In various aspects, the computer system 210 of FIG. 10, the imagingmodule 238 and/or visualization system 208, and/or the processor module232 of FIGS. 9-10, may comprise an image processor, image-processingengine, media processor, or any specialized digital signal processor(DSP) used for the processing of digital images. The image processor mayemploy parallel computing with single instruction, multiple data (SIMD)or multiple instruction, multiple data (MIMD) technologies to increasespeed and efficiency. The digital image-processing engine can perform arange of tasks. The image processor may be a system on a chip withmulticore processor architecture.

The communication connection(s) refers to the hardware/software employedto connect the network interface to the bus. While the communicationconnection is shown for illustrative clarity inside the computer system,it can also be external to the computer system 210. Thehardware/software necessary for connection to the network interfaceincludes, for illustrative purposes only, internal and externaltechnologies such as modems, including regular telephone-grade modems,cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

FIG. 11 illustrates a functional block diagram of one aspect of a USBnetwork hub 300 device, in accordance with at least one aspect of thepresent disclosure. In the illustrated aspect, the USB network hubdevice 300 employs a TUSB2036 integrated circuit hub by TexasInstruments. The USB network hub 300 is a CMOS device that provides anupstream USB transceiver port 302 and up to three downstream USBtransceiver ports 304, 306, 308 in compliance with the USB 2.0specification. The upstream USB transceiver port 302 is a differentialroot data port comprising a differential data minus (DM0) input pairedwith a differential data plus (DP0) input. The three downstream USBtransceiver ports 304, 306, 308 are differential data ports where eachport includes differential data plus (DP1-DP3) outputs paired withdifferential data minus (DM1-DM3) outputs.

The USB network hub 300 device is implemented with a digital statemachine instead of a microcontroller, and no firmware programming isrequired. Fully compliant USB transceivers are integrated into thecircuit for the upstream USB transceiver port 302 and all downstream USBtransceiver ports 304, 306, 308. The downstream USB transceiver ports304, 306, 308 support both full-speed and low-speed devices byautomatically setting the slew rate according to the speed of the deviceattached to the ports. The USB network hub 300 device may be configuredeither in bus-powered or self-powered mode and includes a hub powerlogic 312 to manage power.

The USB network hub 300 device includes a serial interface engine 310(SIE). The SIE 310 is the front end of the USB network hub 300 hardwareand handles most of the protocol described in chapter 8 of the USBspecification. The SIE 310 typically comprehends signaling up to thetransaction level. The functions that it handles could include: packetrecognition, transaction sequencing, SOP, EOP, RESET, and RESUME signaldetection/generation, clock/data separation, non-return-to-zero invert(NRZI) data encoding/decoding and bit-stuffing, CRC generation andchecking (token and data), packet ID (PID) generation andchecking/decoding, and/or serial-parallel/parallel-serial conversion.The 310 receives a clock input 314 and is coupled to a suspend/resumelogic and frame timer 316 circuit and a hub repeater circuit 318 tocontrol communication between the upstream USB transceiver port 302 andthe downstream USB transceiver ports 304, 306, 308 through port logiccircuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326via interface logic to control commands from a serial EEPROM via aserial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functionsconfigured in up to six logical layers (tiers) to a single computer.Further, the USB network hub 300 can connect to all peripherals using astandardized four-wire cable that provides both communication and powerdistribution. The power configurations are bus-powered and self-poweredmodes. The USB network hub 300 may be configured to support four modesof power management: a bus-powered hub, with either individual-portpower management or ganged-port power management, and the self-poweredhub, with either individual-port power management or ganged-port powermanagement. In one aspect, using a USB cable, the USB network hub 300,the upstream USB transceiver port 302 is plugged into a USB hostcontroller, and the downstream USB transceiver ports 304, 306, 308 areexposed for connecting USB compatible devices, and so forth.

Surgical Instrument Hardware

FIG. 12 illustrates a logic diagram of a control system 470 of asurgical instrument or tool in accordance with one or more aspects ofthe present disclosure. The system 470 comprises a control circuit. Thecontrol circuit includes a microcontroller 461 comprising a processor462 and a memory 468. One or more of sensors 472, 474, 476, for example,provide real-time feedback to the processor 462. A motor 482, driven bya motor driver 492, operably couples a longitudinally movabledisplacement member to drive a clamp arm closure member. A trackingsystem 480 is configured to determine the position of the longitudinallymovable displacement member. The position information is provided to theprocessor 462, which can be programmed or configured to determine theposition of the longitudinally movable drive member as well as theposition of the closure member. Additional motors may be provided at thetool driver interface to control closure tube travel, shaft rotation,articulation, or clamp arm closure, or a combination of the above. Adisplay 473 displays a variety of operating conditions of theinstruments and may include touch screen functionality for data input.Information displayed on the display 473 may be overlaid with imagesacquired via endoscopic imaging modules.

In one aspect, the microcontroller 461 may be any single-core ormulticore processor such as those known under the trade name ARM Cortexby Texas Instruments. In one aspect, the main microcontroller 461 may bean LM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare® software,a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/orone or more 12-bit ADCs with 12 analog input channels, details of whichare available for the product datasheet.

In one aspect, the microcontroller 461 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 461 may be programmed to perform various functionssuch as precise control over the speed and position of the knife,articulation systems, clamp arm, or a combination of the above. In oneaspect, the microcontroller 461 includes a processor 462 and a memory468. The electric motor 482 may be a brushed direct current (DC) motorwith a gearbox and mechanical links to an articulation or knife system.In one aspect, a motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. Other motor drivers may be readily substituted foruse in the tracking system 480 comprising an absolute positioningsystem. A detailed description of an absolute positioning system isdescribed in U.S. Patent Application Publication No. 2017/0296213,titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICAL STAPLING ANDCUTTING INSTRUMENT, which published on Oct. 19, 2017, which is hereinincorporated by reference in its entirety.

The microcontroller 461 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 461 may be configured to compute a responsein the software of the microcontroller 461. The computed response iscompared to a measured response of the actual system to obtain an“observed” response, which is used for actual feedback decisions. Theobserved response is a favorable, tuned value that balances the smooth,continuous nature of the simulated response with the measured response,which can detect outside influences on the system.

In one aspect, the motor 482 may be controlled by the motor driver 492and can be employed by the firing system of the surgical instrument ortool. In various forms, the motor 482 may be a brushed DC driving motorhaving a maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 482 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 492 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 482can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery which mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable battery cells. In at least one example,the battery cells can be lithium-ion batteries which can be couplable toand separable from the power assembly.

The motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. The A3941 492 is a full-bridge controller for usewith external N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 492 comprises a unique charge pump regulatorthat provides full (>10 V) gate drive for battery voltages down to 7 Vand allows the A3941 to operate with a reduced gate drive, down to 5.5V. A bootstrap capacitor may be employed to provide the above batterysupply voltage required for N-channel MOSFETs. An internal charge pumpfor the high-side drive allows DC (100% duty cycle) operation. The fullbridge can be driven in fast or slow decay modes using diode orsynchronous rectification. In the slow decay mode, current recirculationcan be through the high-side or the low-side FETs. The power FETs areprotected from shoot-through by resistor-adjustable dead time.Integrated diagnostics provide indications of undervoltage,overtemperature, and power bridge faults and can be configured toprotect the power MOSFETs under most short circuit conditions. Othermotor drivers may be readily substituted for use in the tracking system480 comprising an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuitarrangement comprising a position sensor 472 according to one aspect ofthis disclosure. The position sensor 472 for an absolute positioningsystem provides a unique position signal corresponding to the locationof a displacement member. In one aspect, the displacement memberrepresents a longitudinally movable drive member comprising a rack ofdrive teeth for meshing engagement with a corresponding drive gear of agear reducer assembly. In other aspects, the displacement memberrepresents the firing member, which could be adapted and configured toinclude a rack of drive teeth. In yet another aspect, the displacementmember represents a longitudinal displacement member to open and close aclamp arm, which can be adapted and configured to include a rack ofdrive teeth. In other aspects, the displacement member represents aclamp arm closure member configured to close and to open a clamp arm ofa stapler, ultrasonic, or electrosurgical device, or combinations of theabove. Accordingly, as used herein, the term displacement member is usedgenerically to refer to any movable member of the surgical instrument ortool such as the drive member, the clamp arm, or any element that can bedisplaced. Accordingly, the absolute positioning system can, in effect,track the displacement of the clamp arm by tracking the lineardisplacement of the longitudinally movable drive member. In otheraspects, the absolute positioning system can be configured to track theposition of a clamp arm in the process of closing or opening. In variousother aspects, the displacement member may be coupled to any positionsensor 472 suitable for measuring linear displacement. Thus, thelongitudinally movable drive member, or clamp arm, or combinationsthereof, may be coupled to any suitable linear displacement sensor.Linear displacement sensors may include contact or non-contactdisplacement sensors. Linear displacement sensors may comprise linearvariable differential transformers (LVDT), differential variablereluctance transducers (DVRT), a slide potentiometer, a magnetic sensingsystem comprising a movable magnet and a series of linearly arrangedHall effect sensors, a magnetic sensing system comprising a fixed magnetand a series of movable, linearly arranged Hall effect sensors, anoptical sensing system comprising a movable light source and a series oflinearly arranged photo diodes or photo detectors, an optical sensingsystem comprising a fixed light source and a series of movable linearly,arranged photo diodes or photo detectors, or any combination thereof.

The electric motor 482 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack, of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 472 element corresponds to some linearlongitudinal translation of the displacement member. An arrangement ofgearing and sensors can be connected to the linear actuator, via a rackand pinion arrangement, or a rotary actuator, via a spur gear or otherconnection. A power source supplies power to the absolute positioningsystem and an output indicator may display the output of the absolutepositioning system. The displacement member represents thelongitudinally movable drive member comprising a rack of drive teethformed thereon for meshing engagement with a corresponding drive gear ofthe gear reducer assembly. The displacement member represents thelongitudinally movable firing member to open and close a clamp arm.

A single revolution of the sensor element associated with the positionsensor 472 is equivalent to a longitudinal linear displacement d₁ of thedisplacement member, where d₁ is the longitudinal linear distance thatthe displacement member moves from point “a” to point “b” after a singlerevolution of the sensor element coupled to the displacement member. Thesensor arrangement may be connected via a gear reduction that results inthe position sensor 472 completing one or more revolutions for the fullstroke of the displacement member. The position sensor 472 may completemultiple revolutions for the full stroke of the displacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 472. The state of the switches are fed back to themicrocontroller 461 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d₁+d₂+ . .. d_(n) of the displacement member. The output of the position sensor472 is provided to the microcontroller 461. The position sensor 472 ofthe sensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 472 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic,and microelectromechanical systems-based magnetic sensors, among others.

In one aspect, the position sensor 472 for the tracking system 480comprising an absolute positioning system comprises a magnetic rotaryabsolute positioning system. The position sensor 472 may be implementedas an AS5055EQFT single-chip magnetic rotary position sensor availablefrom Austria Microsystems, AG. The position sensor 472 is interfacedwith the microcontroller 461 to provide an absolute positioning system.The position sensor 472 is a low-voltage and low-power component andincludes four Hall-effect elements in an area of the position sensor 472that is located above a magnet. A high-resolution ADC and a smart powermanagement controller are also provided on the chip. A coordinaterotation digital computer (CORDIC) processor, also known as thedigit-by-digit method and Volder's algorithm, is provided to implement asimple and efficient algorithm to calculate hyperbolic and trigonometricfunctions that require only addition, subtraction, bitshift, and tablelookup operations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface, such as a serial peripheral interface (SPI) interface, to themicrocontroller 461. The position sensor 472 provides 12 or 14 bits ofresolution. The position sensor 472 may be an AS5055 chip provided in asmall QFN 16-pin 4×4×0.85 mm package.

The tracking system 480 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 472. In some aspects, the othersensor(s) can include sensor arrangements such as those described inU.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM, which issued on May 24, 2016, which is herein incorporated byreference in its entirety; U.S. Patent Application Publication No.2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which published on Sep. 18, 2014, which is herein incorporated byreference in its entirety; and U.S. patent application Ser. No.15/628,175, titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OFA SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, whichis herein incorporated by reference in its entirety. In a digital signalprocessing system, an absolute positioning system is coupled to adigital data acquisition system where the output of the absolutepositioning system will have a finite resolution and sampling frequency.The absolute positioning system may comprise a compare-and-combinecircuit to combine a computed response with a measured response usingalgorithms, such as a weighted average and a theoretical control loop,that drive the computed response towards the measured response. Thecomputed response of the physical system takes into account propertieslike mass, inertia, viscous friction, inductance resistance, etc., topredict what the states and outputs of the physical system will be byknowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 482 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 474, such as, for example, a strain gauge or a micro-straingauge, is configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain is converted toa digital signal and provided to the processor 462. Alternatively, or inaddition to the sensor 474, a sensor 476, such as, for example, a loadsensor, can measure the closure force applied by the closure drivesystem to the anvil in a stapler or a clamp arm in an ultrasonic orelectrosurgical instrument. The sensor 476, such as, for example, a loadsensor, can measure the firing force applied to a closure member coupledto a clamp arm of the surgical instrument or tool or the force appliedby a clamp arm to tissue located in the jaws of an ultrasonic orelectrosurgical instrument. Alternatively, a current sensor 478 can beemployed to measure the current drawn by the motor 482. The displacementmember also may be configured to engage a clamp arm to open or close theclamp arm. The force sensor may be configured to measure the clampingforce on tissue. The force required to advance the displacement membercan correspond to the current drawn by the motor 482, for example. Themeasured force is converted to a digital signal and provided to theprocessor 462.

In one form, the strain gauge sensor 474 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector comprises a strain gauge sensor474, such as, for example, a micro-strain gauge, that is configured tomeasure one or more parameters of the end effector, for example. In oneaspect, the strain gauge sensor 474 can measure the amplitude ormagnitude of the strain exerted on a jaw member of an end effectorduring a clamping operation, which can be indicative of the tissuecompression. The measured strain is converted to a digital signal andprovided to a processor 462 of the microcontroller 461. A load sensor476 can measure the force used to operate the knife element, forexample, to cut the tissue captured between the anvil and the staplecartridge. A load sensor 476 can measure the force used to operate theclamp arm element, for example, to capture tissue between the clamp armand an ultrasonic blade or to capture tissue between the clamp arm and ajaw of an electrosurgical instrument. A magnetic field sensor can beemployed to measure the thickness of the captured tissue. Themeasurement of the magnetic field sensor also may be converted to adigital signal and provided to the processor 462.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 474, 476, can be used by themicrocontroller 461 to characterize the selected position of the firingmember and/or the corresponding value of the speed of the firing member.In one instance, a memory 468 may store a technique, an equation, and/ora lookup table which can be employed by the microcontroller 461 in theassessment.

The control system 470 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub as shown in FIGS. 8-11.

FIG. 13 illustrates a control circuit 500 configured to control aspectsof the surgical instrument or tool according to one aspect of thisdisclosure. The control circuit 500 can be configured to implementvarious processes described herein. The control circuit 500 may comprisea microcontroller comprising one or more processors 502 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit504. The memory circuit 504 stores machine-executable instructions that,when executed by the processor 502, cause the processor 502 to executemachine instructions to implement various processes described herein.The processor 502 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 504 may comprisevolatile and non-volatile storage media. The processor 502 may includean instruction processing unit 506 and an arithmetic unit 508. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 504 of this disclosure.

FIG. 14 illustrates a combinational logic circuit 510 configured tocontrol aspects of the surgical instrument or tool according to oneaspect of this disclosure. The combinational logic circuit 510 can beconfigured to implement various processes described herein. Thecombinational logic circuit 510 may comprise a finite state machinecomprising a combinational logic 512 configured to receive dataassociated with the surgical instrument or tool at an input 514, processthe data by the combinational logic 512, and provide an output 516.

FIG. 15 illustrates a sequential logic circuit 520 configured to controlaspects of the surgical instrument or tool according to one aspect ofthis disclosure. The sequential logic circuit 520 or the combinationallogic 522 can be configured to implement various processes describedherein. The sequential logic circuit 520 may comprise a finite statemachine. The sequential logic circuit 520 may comprise a combinationallogic 522, at least one memory circuit 524, and a clock 529, forexample. The at least one memory circuit 524 can store a current stateof the finite state machine. In certain instances, the sequential logiccircuit 520 may be synchronous or asynchronous. The combinational logic522 is configured to receive data associated with the surgicalinstrument or tool from an input 526, process the data by thecombinational logic 522, and provide an output 528. In other aspects,the circuit may comprise a combination of a processor (e.g., processor502, FIG. 13) and a finite state machine to implement various processesherein. In other aspects, the finite state machine may comprise acombination of a combinational logic circuit (e.g., combinational logiccircuit 510, FIG. 14) and the sequential logic circuit 520.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions. Incertain instances, a first motor can be activated to perform a firstfunction, a second motor can be activated to perform a second function,a third motor can be activated to perform a third function, a fourthmotor can be activated to perform a fourth function, and so on. Incertain instances, the plurality of motors of robotic surgicalinstrument 600 can be individually activated to cause firing, closure,and/or articulation motions in the end effector. The firing, closure,and/or articulation motions can be transmitted to the end effectorthrough a shaft assembly, for example.

In certain instances, the surgical instrument system or tool may includea firing motor 602. The firing motor 602 may be operably coupled to afiring motor drive assembly 604 which can be configured to transmitfiring motions, generated by the motor 602 to the end effector, inparticular to displace the clamp arm closure member. The closure membermay be retracted by reversing the direction of the motor 602, which alsocauses the clamp arm to open.

In certain instances, the surgical instrument or tool may include aclosure motor 603. The closure motor 603 may be operably coupled to aclosure motor drive assembly 605 which can be configured to transmitclosure motions, generated by the motor 603 to the end effector, inparticular to displace a closure tube to close the anvil and compresstissue between the anvil and the staple cartridge. The closure motor 603may be operably coupled to a closure motor drive assembly 605 which canbe configured to transmit closure motions, generated by the motor 603 tothe end effector, in particular to displace a closure tube to close theclamp arm and compress tissue between the clamp arm and either anultrasonic blade or jaw member of an electrosurgical device. The closuremotions may cause the end effector to transition from an openconfiguration to an approximated configuration to capture tissue, forexample. The end effector may be transitioned to an open position byreversing the direction of the motor 603.

In certain instances, the surgical instrument or tool may include one ormore articulation motors 606 a, 606 b, for example. The motors 606 a,606 b may be operably coupled to respective articulation motor driveassemblies 608 a, 608 b, which can be configured to transmitarticulation motions generated by the motors 606 a, 606 b to the endeffector. In certain instances, the articulation motions may cause theend effector to articulate relative to the shaft, for example.

As described above, the surgical instrument or tool may include aplurality of motors which may be configured to perform variousindependent functions. In certain instances, the plurality of motors ofthe surgical instrument or tool can be individually or separatelyactivated to perform one or more functions while the other motors remaininactive. For example, the articulation motors 606 a, 606 b can beactivated to cause the end effector to be articulated while the firingmotor 602 remains inactive. Alternatively, the firing motor 602 can beactivated to fire the plurality of staples, and/or to advance thecutting edge, while the articulation motor 606 remains inactive.Furthermore, the closure motor 603 may be activated simultaneously withthe firing motor 602 to cause the closure tube or closure member toadvance distally as described in more detail hereinbelow.

In certain instances, the surgical instrument or tool may include acommon control module 610 which can be employed with a plurality ofmotors of the surgical instrument or tool. In certain instances, thecommon control module 610 may accommodate one of the plurality of motorsat a time. For example, the common control module 610 can be couplableto and separable from the plurality of motors of the robotic surgicalinstrument individually. In certain instances, a plurality of the motorsof the surgical instrument or tool may share one or more common controlmodules such as the common control module 610. In certain instances, aplurality of motors of the surgical instrument or tool can beindividually and selectively engaged with the common control module 610.In certain instances, the common control module 610 can be selectivelyswitched from interfacing with one of a plurality of motors of thesurgical instrument or tool to interfacing with another one of theplurality of motors of the surgical instrument or tool.

In at least one example, the common control module 610 can beselectively switched between operable engagement with the articulationmotors 606 a, 606 b and operable engagement with either the firing motor602 or the closure motor 603. In at least one example, as illustrated inFIG. 16, a switch 614 can be moved or transitioned between a pluralityof positions and/or states. In a first position 616, the switch 614 mayelectrically couple the common control module 610 to the firing motor602; in a second position 617, the switch 614 may electrically couplethe common control module 610 to the closure motor 603; in a thirdposition 618 a, the switch 614 may electrically couple the commoncontrol module 610 to the first articulation motor 606 a; and in afourth position 618 b, the switch 614 may electrically couple the commoncontrol module 610 to the second articulation motor 606 b, for example.In certain instances, separate common control modules 610 can beelectrically coupled to the firing motor 602, the closure motor 603, andthe articulations motor 606 a, 606 b at the same time. In certaininstances, the switch 614 may be a mechanical switch, anelectromechanical switch, a solid-state switch, or any suitableswitching mechanism.

Each of the motors 602, 603, 606 a, 606 b may comprise a torque sensorto measure the output torque on the shaft of the motor. The force on anend effector may be sensed in any conventional manner, such as by forcesensors on the outer sides of the jaws or by a torque sensor for themotor actuating the jaws.

In various instances, as illustrated in FIG. 16, the common controlmodule 610 may comprise a motor driver 626 which may comprise one ormore H-Bridge FETs. The motor driver 626 may modulate the powertransmitted from a power source 628 to a motor coupled to the commoncontrol module 610 based on input from a microcontroller 620 (the“controller”), for example. In certain instances, the microcontroller620 can be employed to determine the current drawn by the motor, forexample, while the motor is coupled to the common control module 610, asdescribed above.

In certain instances, the microcontroller 620 may include amicroprocessor 622 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 624 (the “memory”). In certaininstances, the memory 624 may store various program instructions, whichwhen executed may cause the processor 622 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 624 may be coupled to the processor 622,for example. In various aspects, the microcontroller 620 may communicateover a wired or wireless channel, or combinations thereof.

In certain instances, the power source 628 can be employed to supplypower to the microcontroller 620, for example. In certain instances, thepower source 628 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source628. In certain instances, the power source 628 may be replaceableand/or rechargeable, for example.

In various instances, the processor 622 may control the motor driver 626to control the position, direction of rotation, and/or velocity of amotor that is coupled to the common control module 610. In certaininstances, the processor 622 can signal the motor driver 626 to stopand/or disable a motor that is coupled to the common control module 610.It should be understood that the term “processor” as used hereinincludes any suitable microprocessor, microcontroller, or other basiccomputing device that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor 622 is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 622 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the module 4410. Accordingly, the present disclosure should notbe limited in this context.

In certain instances, the memory 624 may include program instructionsfor controlling each of the motors of the surgical instrument 600 thatare couplable to the common control module 610. For example, the memory624 may include program instructions for controlling the firing motor602, the closure motor 603, and the articulation motors 606 a, 606 b.Such program instructions may cause the processor 622 to control thefiring, closure, and articulation functions in accordance with inputsfrom algorithms or control programs of the surgical instrument or tool.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 630 can be employed to alert the processor 622 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 630 may alert the processor 622 to use the programinstructions associated with firing, closing, and articulating the endeffector. In certain instances, the sensors 630 may comprise positionsensors which can be employed to sense the position of the switch 614,for example. Accordingly, the processor 622 may use the programinstructions associated with firing the closure member coupled to theclamp arm of the end effector upon detecting, through the sensors 630for example, that the switch 614 is in the first position 616; theprocessor 622 may use the program instructions associated with closingthe anvil upon detecting, through the sensors 630 for example, that theswitch 614 is in the second position 617; and the processor 622 may usethe program instructions associated with articulating the end effectorupon detecting, through the sensors 630 for example, that the switch 614is in the third or fourth position 618 a, 618 b.

FIG. 17 is a schematic diagram of a robotic surgical instrument 700configured to operate a surgical tool described herein according to oneaspect of this disclosure. The robotic surgical instrument 700 may beprogrammed or configured to control distal/proximal translation of adisplacement member, distal/proximal displacement of a closure tube,shaft rotation, and articulation, either with single or multiplearticulation drive links. In one aspect, the surgical instrument 700 maybe programmed or configured to individually control a firing member, aclosure member, a shaft member, or one or more articulation members, orcombinations thereof. The surgical instrument 700 comprises a controlcircuit 710 configured to control motor-driven firing members, closuremembers, shaft members, or one or more articulation members, orcombinations thereof.

In one aspect, the robotic surgical instrument 700 comprises a controlcircuit 710 configured to control a clamp arm 716 and a closure member714 portion of an end effector 702, an ultrasonic blade 718 coupled toan ultrasonic transducer 719 excited by an ultrasonic generator 721, ashaft 740, and one or more articulation members 742 a, 742 b via aplurality of motors 704 a-704 e. A position sensor 734 may be configuredto provide position feedback of the closure member 714 to the controlcircuit 710. Other sensors 738 may be configured to provide feedback tothe control circuit 710. A timer/counter 731 provides timing andcounting information to the control circuit 710. An energy source 712may be provided to operate the motors 704 a-704 e, and a current sensor736 provides motor current feedback to the control circuit 710. Themotors 704 a-704 e can be operated individually by the control circuit710 in an open-loop or closed-loop feedback control.

In one aspect, the control circuit 710 may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to performone or more tasks. In one aspect, a timer/counter 731 provides an outputsignal, such as the elapsed time or a digital count, to the controlcircuit 710 to correlate the position of the closure member 714 asdetermined by the position sensor 734 with the output of thetimer/counter 731 such that the control circuit 710 can determine theposition of the closure member 714 at a specific time (t) relative to astarting position or the time (t) when the closure member 714 is at aspecific position relative to a starting position. The timer/counter 731may be configured to measure elapsed time, count external events, ortime external events.

In one aspect, the control circuit 710 may be programmed to controlfunctions of the end effector 702 based on one or more tissueconditions. The control circuit 710 may be programmed to sense tissueconditions, such as thickness, either directly or indirectly, asdescribed herein. The control circuit 710 may be programmed to select afiring control program or closure control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 710 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 710 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power. A closure control program may control theclosure force applied to the tissue by the clamp arm 716. Other controlprograms control the rotation of the shaft 740 and the articulationmembers 742 a, 742 b.

In one aspect, the control circuit 710 may generate motor set pointsignals. The motor set point signals may be provided to various motorcontrollers 708 a-708 e. The motor controllers 708 a-708 e may compriseone or more circuits configured to provide motor drive signals to themotors 704 a-704 e to drive the motors 704 a-704 e as described herein.In some examples, the motors 704 a-704 e may be brushed DC electricmotors. For example, the velocity of the motors 704 a-704 e may beproportional to the respective motor drive signals. In some examples,the motors 704 a-704 e may be brushless DC electric motors, and therespective motor drive signals may comprise a PWM signal provided to oneor more stator windings of the motors 704 a-704 e. Also, in someexamples, the motor controllers 708 a-708 e may be omitted and thecontrol circuit 710 may generate the motor drive signals directly.

In one aspect, the control circuit 710 may initially operate each of themotors 704 a-704 e in an open-loop configuration for a first open-loopportion of a stroke of the displacement member. Based on the response ofthe robotic surgical instrument 700 during the open-loop portion of thestroke, the control circuit 710 may select a firing control program in aclosed-loop configuration. The response of the instrument may include atranslation distance of the displacement member during the open-loopportion, a time elapsed during the open-loop portion, the energyprovided to one of the motors 704 a-704 e during the open-loop portion,a sum of pulse widths of a motor drive signal, etc. After the open-loopportion, the control circuit 710 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during a closed-loop portion of the stroke, the controlcircuit 710 may modulate one of the motors 704 a-704 e based ontranslation data describing a position of the displacement member in aclosed-loop manner to translate the displacement member at a constantvelocity.

In one aspect, the motors 704 a-704 e may receive power from an energysource 712. The energy source 712 may be a DC power supply driven by amain alternating current power source, a battery, a super capacitor, orany other suitable energy source. The motors 704 a-704 e may bemechanically coupled to individual movable mechanical elements such asthe closure member 714, clamp arm 716, shaft 740, articulation 742 a,and articulation 742 b via respective transmissions 706 a-706 e. Thetransmissions 706 a-706 e may include one or more gears or other linkagecomponents to couple the motors 704 a-704 e to movable mechanicalelements. A position sensor 734 may sense a position of the closuremember 714. The position sensor 734 may be or include any type of sensorthat is capable of generating position data that indicate a position ofthe closure member 714. In some examples, the position sensor 734 mayinclude an encoder configured to provide a series of pulses to thecontrol circuit 710 as the closure member 714 translates distally andproximally. The control circuit 710 may track the pulses to determinethe position of the closure member 714. Other suitable position sensorsmay be used, including, for example, a proximity sensor. Other types ofposition sensors may provide other signals indicating motion of theclosure member 714. Also, in some examples, the position sensor 734 maybe omitted. Where any of the motors 704 a-704 e is a stepper motor, thecontrol circuit 710 may track the position of the closure member 714 byaggregating the number and direction of steps that the motor 704 hasbeen instructed to execute. The position sensor 734 may be located inthe end effector 702 or at any other portion of the instrument. Theoutputs of each of the motors 704 a-704 e include a torque sensor 744a-744 e to sense force and have an encoder to sense rotation of thedrive shaft.

In one aspect, the control circuit 710 is configured to drive a firingmember such as the closure member 714 portion of the end effector 702.The control circuit 710 provides a motor set point to a motor control708 a, which provides a drive signal to the motor 704 a. The outputshaft of the motor 704 a is coupled to a torque sensor 744 a. The torquesensor 744 a is coupled to a transmission 706 a which is coupled to theclosure member 714. The transmission 706 a comprises movable mechanicalelements such as rotating elements and a firing member to control themovement of the closure member 714 distally and proximally along alongitudinal axis of the end effector 702. In one aspect, the motor 704a may be coupled to the knife gear assembly, which includes a knife gearreduction set that includes a first knife drive gear and a second knifedrive gear. A torque sensor 744 a provides a firing force feedbacksignal to the control circuit 710. The firing force signal representsthe force required to fire or displace the closure member 714. Aposition sensor 734 may be configured to provide the position of theclosure member 714 along the firing stroke or the position of the firingmember as a feedback signal to the control circuit 710. The end effector702 may include additional sensors 738 configured to provide feedbacksignals to the control circuit 710. When ready to use, the controlcircuit 710 may provide a firing signal to the motor control 708 a. Inresponse to the firing signal, the motor 704 a may drive the firingmember distally along the longitudinal axis of the end effector 702 froma proximal stroke start position to a stroke end position distal to thestroke start position. As the closure member 714 translates distally,the clamp arm 716 closes towards the ultrasonic blade 718.

In one aspect, the control circuit 710 is configured to drive a closuremember such as the clamp arm 716 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 b,which provides a drive signal to the motor 704 b. The output shaft ofthe motor 704 b is coupled to a torque sensor 744 b. The torque sensor744 b is coupled to a transmission 706 b which is coupled to the clamparm 716. The transmission 706 b comprises movable mechanical elementssuch as rotating elements and a closure member to control the movementof the clamp arm 716 from the open and closed positions. In one aspect,the motor 704 b is coupled to a closure gear assembly, which includes aclosure reduction gear set that is supported in meshing engagement withthe closure spur gear. The torque sensor 744 b provides a closure forcefeedback signal to the control circuit 710. The closure force feedbacksignal represents the closure force applied to the clamp arm 716. Theposition sensor 734 may be configured to provide the position of theclosure member as a feedback signal to the control circuit 710.Additional sensors 738 in the end effector 702 may provide the closureforce feedback signal to the control circuit 710. The pivotable clamparm 716 is positioned opposite the ultrasonic blade 718. When ready touse, the control circuit 710 may provide a closure signal to the motorcontrol 708 b. In response to the closure signal, the motor 704 badvances a closure member to grasp tissue between the clamp arm 716 andthe ultrasonic blade 718.

In one aspect, the control circuit 710 is configured to rotate a shaftmember such as the shaft 740 to rotate the end effector 702. The controlcircuit 710 provides a motor set point to a motor control 708 c, whichprovides a drive signal to the motor 704 c. The output shaft of themotor 704 c is coupled to a torque sensor 744 c. The torque sensor 744 cis coupled to a transmission 706 c which is coupled to the shaft 740.The transmission 706 c comprises movable mechanical elements such asrotating elements to control the rotation of the shaft 740 clockwise orcounterclockwise up to and over 360°. In one aspect, the motor 704 c iscoupled to the rotational transmission assembly, which includes a tubegear segment that is formed on (or attached to) the proximal end of theproximal closure tube for operable engagement by a rotational gearassembly that is operably supported on the tool mounting plate. Thetorque sensor 744 c provides a rotation force feedback signal to thecontrol circuit 710. The rotation force feedback signal represents therotation force applied to the shaft 740. The position sensor 734 may beconfigured to provide the position of the closure member as a feedbacksignal to the control circuit 710. Additional sensors 738 such as ashaft encoder may provide the rotational position of the shaft 740 tothe control circuit 710.

In one aspect, the control circuit 710 is configured to articulate theend effector 702. The control circuit 710 provides a motor set point toa motor control 708 d, which provides a drive signal to the motor 704 d.The output shaft of the motor 704 d is coupled to a torque sensor 744 d.The torque sensor 744 d is coupled to a transmission 706 d which iscoupled to an articulation member 742 a. The transmission 706 dcomprises movable mechanical elements such as articulation elements tocontrol the articulation of the end effector 702±65°. In one aspect, themotor 704 d is coupled to an articulation nut, which is rotatablyjournaled on the proximal end portion of the distal spine portion and isrotatably driven thereon by an articulation gear assembly. The torquesensor 744 d provides an articulation force feedback signal to thecontrol circuit 710. The articulation force feedback signal representsthe articulation force applied to the end effector 702. Sensors 738,such as an articulation encoder, may provide the articulation positionof the end effector 702 to the control circuit 710.

In another aspect, the articulation function of the robotic surgicalsystem 700 may comprise two articulation members, or links, 742 a, 742b. These articulation members 742 a, 742 b are driven by separate diskson the robot interface (the rack) which are driven by the two motors 708d, 708 e. When the separate firing motor 704 a is provided, each ofarticulation links 742 a, 742 b can be antagonistically driven withrespect to the other link in order to provide a resistive holding motionand a load to the head when it is not moving and to provide anarticulation motion as the head is articulated. The articulation members742 a, 742 b attach to the head at a fixed radius as the head isrotated. Accordingly, the mechanical advantage of the push-and-pull linkchanges as the head is rotated. This change in the mechanical advantagemay be more pronounced with other articulation link drive systems.

In one aspect, the one or more motors 704 a-704 e may comprise a brushedDC motor with a gearbox and mechanical links to a firing member, closuremember, or articulation member. Another example includes electric motors704 a-704 e that operate the movable mechanical elements such as thedisplacement member, articulation links, closure tube, and shaft. Anoutside influence is an unmeasured, unpredictable influence of thingslike tissue, surrounding bodies, and friction on the physical system.Such outside influence can be referred to as drag, which acts inopposition to one of electric motors 704 a-704 e. The outside influence,such as drag, may cause the operation of the physical system to deviatefrom a desired operation of the physical system.

In one aspect, the position sensor 734 may be implemented as an absolutepositioning system. In one aspect, the position sensor 734 may comprisea magnetic rotary absolute positioning system implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 734 may interface with thecontrol circuit 710 to provide an absolute positioning system. Theposition may include multiple Hall-effect elements located above amagnet and coupled to a CORDIC processor, also known as thedigit-by-digit method and Volder's algorithm, that is provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bitshift, and table lookup operations.

In one aspect, the control circuit 710 may be in communication with oneor more sensors 738. The sensors 738 may be positioned on the endeffector 702 and adapted to operate with the robotic surgical instrument700 to measure the various derived parameters such as the gap distanceversus time, tissue compression versus time, and anvil strain versustime. The sensors 738 may comprise a magnetic sensor, a magnetic fieldsensor, a strain gauge, a load cell, a pressure sensor, a force sensor,a torque sensor, an inductive sensor such as an eddy current sensor, aresistive sensor, a capacitive sensor, an optical sensor, and/or anyother suitable sensor for measuring one or more parameters of the endeffector 702. The sensors 738 may include one or more sensors. Thesensors 738 may be located on the clamp arm 716 to determine tissuelocation using segmented electrodes. The torque sensors 744 a-744 e maybe configured to sense force such as firing force, closure force, and/orarticulation force, among others. Accordingly, the control circuit 710can sense (1) the closure load experienced by the distal closure tubeand its position, (2) the firing member at the rack and its position,(3) what portion of the ultrasonic blade 718 has tissue on it, and (4)the load and position on both articulation rods.

In one aspect, the one or more sensors 738 may comprise a strain gauge,such as a micro-strain gauge, configured to measure the magnitude of thestrain in the clamp arm 716 during a clamped condition. The strain gaugeprovides an electrical signal whose amplitude varies with the magnitudeof the strain. The sensors 738 may comprise a pressure sensor configuredto detect a pressure generated by the presence of compressed tissuebetween the clamp arm 716 and the ultrasonic blade 718. The sensors 738may be configured to detect impedance of a tissue section locatedbetween the clamp arm 716 and the ultrasonic blade 718 that isindicative of the thickness and/or fullness of tissue locatedtherebetween.

In one aspect, the sensors 738 may be implemented as one or more limitswitches, electromechanical devices, solid-state switches, Hall-effectdevices, magneto-resistive (MR) devices, giant magneto-resistive (GMR)devices, magnetometers, among others. In other implementations, thesensors 738 may be implemented as solid-state switches that operateunder the influence of light, such as optical sensors, IR sensors,ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors738 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the sensors 738 may be configured to measure forcesexerted on the clamp arm 716 by the closure drive system. For example,one or more sensors 738 can be at an interaction point between theclosure tube and the clamp arm 716 to detect the closure forces appliedby the closure tube to the clamp arm 716. The forces exerted on theclamp arm 716 can be representative of the tissue compressionexperienced by the tissue section captured between the clamp arm 716 andthe ultrasonic blade 718. The one or more sensors 738 can be positionedat various interaction points along the closure drive system to detectthe closure forces applied to the clamp arm 716 by the closure drivesystem. The one or more sensors 738 may be sampled in real time during aclamping operation by the processor of the control circuit 710. Thecontrol circuit 710 receives real-time sample measurements to provideand analyze time-based information and assess, in real time, closureforces applied to the clamp arm 716.

In one aspect, a current sensor 736 can be employed to measure thecurrent drawn by each of the motors 704 a-704 e. The force required toadvance any of the movable mechanical elements such as the closuremember 714 corresponds to the current drawn by one of the motors 704a-704 e. The force is converted to a digital signal and provided to thecontrol circuit 710. The control circuit 710 can be configured tosimulate the response of the actual system of the instrument in thesoftware of the controller. A displacement member can be actuated tomove the closure member 714 in the end effector 702 at or near a targetvelocity. The robotic surgical instrument 700 can include a feedbackcontroller, which can be one of any feedback controllers, including, butnot limited to a PID, a state feedback, a linear-quadratic (LQR), and/oran adaptive controller, for example. The robotic surgical instrument 700can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.Additional details are disclosed in U.S. patent application Ser. No.15/636,829, titled CLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTICSURGICAL INSTRUMENT, filed Jun. 29, 2017, which is herein incorporatedby reference in its entirety.

FIG. 18 illustrates a schematic diagram of a surgical instrument 750configured to control the distal translation of a displacement memberaccording to one aspect of this disclosure. In one aspect, the surgicalinstrument 750 is programmed to control the distal translation of adisplacement member such as the closure member 764. The surgicalinstrument 750 comprises an end effector 752 that may comprise a clamparm 766, a closure member 764, and an ultrasonic blade 768 coupled to anultrasonic transducer 769 driven by an ultrasonic generator 771.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the closure member 764, can be measured byan absolute positioning system, sensor arrangement, and position sensor784. Because the closure member 764 is coupled to a longitudinallymovable drive member, the position of the closure member 764 can bedetermined by measuring the position of the longitudinally movable drivemember employing the position sensor 784. Accordingly, in the followingdescription, the position, displacement, and/or translation of theclosure member 764 can be achieved by the position sensor 784 asdescribed herein. A control circuit 760 may be programmed to control thetranslation of the displacement member, such as the closure member 764.The control circuit 760, in some examples, may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to controlthe displacement member, e.g., the closure member 764, in the mannerdescribed. In one aspect, a timer/counter 781 provides an output signal,such as the elapsed time or a digital count, to the control circuit 760to correlate the position of the closure member 764 as determined by theposition sensor 784 with the output of the timer/counter 781 such thatthe control circuit 760 can determine the position of the closure member764 at a specific time (t) relative to a starting position. Thetimer/counter 781 may be configured to measure elapsed time, countexternal events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theclosure member 764 via a transmission 756. The transmission 756 mayinclude one or more gears or other linkage components to couple themotor 754 to the closure member 764. A position sensor 784 may sense aposition of the closure member 764. The position sensor 784 may be orinclude any type of sensor that is capable of generating position datathat indicate a position of the closure member 764. In some examples,the position sensor 784 may include an encoder configured to provide aseries of pulses to the control circuit 760 as the closure member 764translates distally and proximally. The control circuit 760 may trackthe pulses to determine the position of the closure member 764. Othersuitable position sensors may be used, including, for example, aproximity sensor. Other types of position sensors may provide othersignals indicating motion of the closure member 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theclosure member 764 by aggregating the number and direction of steps thatthe motor 754 has been instructed to execute. The position sensor 784may be located in the end effector 752 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 752 andadapted to operate with the surgical instrument 750 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 752. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe clamp arm 766 during a clamped condition. The strain gauge providesan electrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe clamp arm 766 and the ultrasonic blade 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theclamp arm 766 and the ultrasonic blade 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theclamp arm 766 by a closure drive system. For example, one or moresensors 788 can be at an interaction point between a closure tube andthe clamp arm 766 to detect the closure forces applied by a closure tubeto the clamp arm 766. The forces exerted on the clamp arm 766 can berepresentative of the tissue compression experienced by the tissuesection captured between the clamp arm 766 and the ultrasonic blade 768.The one or more sensors 788 can be positioned at various interactionpoints along the closure drive system to detect the closure forcesapplied to the clamp arm 766 by the closure drive system. The one ormore sensors 788 may be sampled in real time during a clamping operationby a processor of the control circuit 760. The control circuit 760receives real-time sample measurements to provide and analyze time-basedinformation and assess, in real time, closure forces applied to theclamp arm 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the closure member 764corresponds to the current drawn by the motor 754. The force isconverted to a digital signal and provided to the control circuit 760.

The control circuit 760 can be configured to simulate the response ofthe actual system of the instrument in the software of the controller. Adisplacement member can be actuated to move a closure member 764 in theend effector 752 at or near a target velocity. The surgical instrument750 can include a feedback controller, which can be one of any feedbackcontrollers, including, but not limited to a PID, a state feedback, LQR,and/or an adaptive controller, for example. The surgical instrument 750can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.

The actual drive system of the surgical instrument 750 is configured todrive the displacement member, cutting member, or closure member 764, bya brushed DC motor with gearbox and mechanical links to an articulationand/or knife system. Another example is the electric motor 754 thatoperates the displacement member and the articulation driver, forexample, of an interchangeable shaft assembly. An outside influence isan unmeasured, unpredictable influence of things like tissue,surrounding bodies and friction on the physical system. Such outsideinfluence can be referred to as drag which acts in opposition to theelectric motor 754. The outside influence, such as drag, may cause theoperation of the physical system to deviate from a desired operation ofthe physical system.

Various example aspects are directed to a surgical instrument 750comprising an end effector 752 with motor-driven surgical sealing andcutting implements. For example, a motor 754 may drive a displacementmember distally and proximally along a longitudinal axis of the endeffector 752. The end effector 752 may comprise a pivotable clamp arm766 and, when configured for use, an ultrasonic blade 768 positionedopposite the clamp arm 766. A clinician may grasp tissue between theclamp arm 766 and the ultrasonic blade 768, as described herein. Whenready to use the instrument 750, the clinician may provide a firingsignal, for example by depressing a trigger of the instrument 750. Inresponse to the firing signal, the motor 754 may drive the displacementmember distally along the longitudinal axis of the end effector 752 froma proximal stroke begin position to a stroke end position distal of thestroke begin position. As the displacement member translates distally,the closure member 764 with a cutting element positioned at a distalend, may cut the tissue between the ultrasonic blade 768 and the clamparm 766.

In various examples, the surgical instrument 750 may comprise a controlcircuit 760 programmed to control the distal translation of thedisplacement member, such as the closure member 764, for example, basedon one or more tissue conditions. The control circuit 760 may beprogrammed to sense tissue conditions, such as thickness, eitherdirectly or indirectly, as described herein. The control circuit 760 maybe programmed to select a control program based on tissue conditions. Acontrol program may describe the distal motion of the displacementmember. Different control programs may be selected to better treatdifferent tissue conditions. For example, when thicker tissue ispresent, the control circuit 760 may be programmed to translate thedisplacement member at a lower velocity and/or with lower power. Whenthinner tissue is present, the control circuit 760 may be programmed totranslate the displacement member at a higher velocity and/or withhigher power.

In some examples, the control circuit 760 may initially operate themotor 754 in an open loop configuration for a first open loop portion ofa stroke of the displacement member. Based on a response of theinstrument 750 during the open loop portion of the stroke, the controlcircuit 760 may select a firing control program. The response of theinstrument may include, a translation distance of the displacementmember during the open loop portion, a time elapsed during the open loopportion, energy provided to the motor 754 during the open loop portion,a sum of pulse widths of a motor drive signal, etc. After the open loopportion, the control circuit 760 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during the closed loop portion of the stroke, the controlcircuit 760 may modulate the motor 754 based on translation datadescribing a position of the displacement member in a closed loop mannerto translate the displacement member at a constant velocity. Additionaldetails are disclosed in U.S. patent application Ser. No. 15/720,852,titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICALINSTRUMENT, filed Sep. 29, 2017, which is herein incorporated byreference in its entirety.

FIG. 19 is a schematic diagram of a surgical instrument 790 configuredto control various functions according to one aspect of this disclosure.In one aspect, the surgical instrument 790 is programmed to controldistal translation of a displacement member such as the closure member764. The surgical instrument 790 comprises an end effector 792 that maycomprise a clamp arm 766, a closure member 764, and an ultrasonic blade768 which may be interchanged with or work in conjunction with one ormore RF electrodes 796 (shown in dashed line). The ultrasonic blade 768is coupled to an ultrasonic transducer 769 driven by an ultrasonicgenerator 771.

In one aspect, sensors 788 may be implemented as a limit switch,electromechanical device, solid-state switches, Hall-effect devices, MRdevices, GMR devices, magnetometers, among others. In otherimplementations, the sensors 638 may be solid-state switches thatoperate under the influence of light, such as optical sensors, IRsensors, ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors788 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolutepositioning system comprising a magnetic rotary absolute positioningsystem implemented as an AS5055EQFT single-chip magnetic rotary positionsensor available from Austria Microsystems, AG. The position sensor 784may interface with the control circuit 760 to provide an absolutepositioning system. The position may include multiple Hall-effectelements located above a magnet and coupled to a CORDIC processor, alsoknown as the digit-by-digit method and Volder's algorithm, that isprovided to implement a simple and efficient algorithm to calculatehyperbolic and trigonometric functions that require only addition,subtraction, bitshift, and table lookup operations.

In some examples, the position sensor 784 may be omitted. Where themotor 754 is a stepper motor, the control circuit 760 may track theposition of the closure member 764 by aggregating the number anddirection of steps that the motor has been instructed to execute. Theposition sensor 784 may be located in the end effector 792 or at anyother portion of the instrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 792 andadapted to operate with the surgical instrument 790 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 792. The sensors 788 may include one ormore sensors.

An RF energy source 794 is coupled to the end effector 792 and isapplied to the RF electrode 796 when the RF electrode 796 is provided inthe end effector 792 in place of the ultrasonic blade 768 or to work inconjunction with the ultrasonic blade 768. For example, the ultrasonicblade is made of electrically conductive metal and may be employed asthe return path for electrosurgical RF current. The control circuit 760controls the delivery of the RF energy to the RF electrode 796.

Additional details are disclosed in U.S. patent application Ser. No.15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE ANDRADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28,2017, which is herein incorporated by reference in its entirety.

Generator Hardware

In various aspects smart ultrasonic energy devices may comprise adaptivealgorithms to control the operation of the ultrasonic blade. In oneaspect, the ultrasonic blade adaptive control algorithms are configuredto identify tissue type and adjust device parameters. In one aspect, theultrasonic blade control algorithms are configured to parameterizetissue type. An algorithm to detect the collagen/elastic ratio of tissueto tune the amplitude of the distal tip of the ultrasonic blade isdescribed in the following section of the present disclosure. Variousaspects of smart ultrasonic energy devices are described herein inconnection with FIGS. 12-19, for example. Accordingly, the followingdescription of adaptive ultrasonic blade control algorithms should beread in conjunction with FIGS. 12-19 and the description associatedtherewith.

In certain surgical procedures it would be desirable to employ adaptiveultrasonic blade control algorithms. In one aspect, adaptive ultrasonicblade control algorithms may be employed to adjust the parameters of theultrasonic device based on the type of tissue in contact with theultrasonic blade. In one aspect, the parameters of the ultrasonic devicemay be adjusted based on the location of the tissue within the jaws ofthe ultrasonic end effector, for example, the location of the tissuebetween the clamp arm and the ultrasonic blade. The impedance of theultrasonic transducer may be employed to differentiate what percentageof the tissue is located in the distal or proximal end of the endeffector. The reactions of the ultrasonic device may be based on thetissue type or compressibility of the tissue. In another aspect, theparameters of the ultrasonic device may be adjusted based on theidentified tissue type or parameterization. For example, the mechanicaldisplacement amplitude of the distal tip of the ultrasonic blade may betuned based on the ration of collagen to elastin tissue detected duringthe tissue identification procedure. The ratio of collagen to elastintissue may be detected used a variety of techniques including infrared(IR) surface reflectance and emissivity. The force applied to the tissueby the clamp arm and/or the stroke of the clamp arm to produce gap andcompression. Electrical continuity across a jaw equipped with electrodesmay be employed to determine what percentage of the jaw is covered withtissue.

FIG. 20 is a system 800 configured to execute adaptive ultrasonic bladecontrol algorithms in a surgical data network comprising a modularcommunication hub, in accordance with at least one aspect of the presentdisclosure. In one aspect, the generator module 240 is configured toexecute the adaptive ultrasonic blade control algorithm(s) 802. Inanother aspect, the device/instrument 235 is configured to execute theadaptive ultrasonic blade control algorithm(s) 804. In another aspect,both the generator module 240 and the device/instrument 235 areconfigured to execute the adaptive ultrasonic blade control algorithms802, 804.

The generator module 240 may comprise a patient isolated stage incommunication with a non-isolated stage via a power transformer. Asecondary winding of the power transformer is contained in the isolatedstage and may comprise a tapped configuration (e.g., a center-tapped ora non-center-tapped configuration) to define drive signal outputs fordelivering drive signals to different surgical instruments, such as, forexample, an ultrasonic surgical instrument, an RF electrosurgicalinstrument, and a multifunction surgical instrument which includesultrasonic and RF energy modes that can be delivered alone orsimultaneously. In particular, the drive signal outputs may output anultrasonic drive signal (e.g., a 420V root-mean-square (RMS) drivesignal) to an ultrasonic surgical instrument 241, and the drive signaloutputs may output an RF electrosurgical drive signal (e.g., a 100V RMSdrive signal) to an RF electrosurgical instrument 241. Aspects of thegenerator module 240 are described herein with reference to FIGS. 21-22.

The generator module 240 or the device/instrument 235 or both arecoupled the modular control tower 236 connected to multiple operatingtheater devices such as, for example, intelligent surgical instruments,robots, and other computerized devices located in the operating theater,as described with reference to FIGS. 8-11, for example.

FIG. 21 illustrates an example of a generator 900, which is one form ofa generator configured to couple to an ultrasonic instrument and furtherconfigured to execute adaptive ultrasonic blade control algorithms in asurgical data network comprising a modular communication hub as shown inFIG. 20. The generator 900 is configured to deliver multiple energymodalities to a surgical instrument. The generator 900 provides RF andultrasonic signals for delivering energy to a surgical instrument eitherindependently or simultaneously. The RF and ultrasonic signals may beprovided alone or in combination and may be provided simultaneously. Asnoted above, at least one generator output can deliver multiple energymodalities (e.g., ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers) through a single port, and these signals can be deliveredseparately or simultaneously to the end effector to treat tissue. Thegenerator 900 comprises a processor 902 coupled to a waveform generator904. The processor 902 and waveform generator 904 are configured togenerate a variety of signal waveforms based on information stored in amemory coupled to the processor 902, not shown for clarity ofdisclosure. The digital information associated with a waveform isprovided to the waveform generator 904 which includes one or more DACcircuits to convert the digital input into an analog output. The analogoutput is fed to an amplifier 1106 for signal conditioning andamplification. The conditioned and amplified output of the amplifier 906is coupled to a power transformer 908. The signals are coupled acrossthe power transformer 908 to the secondary side, which is in the patientisolation side. A first signal of a first energy modality is provided tothe surgical instrument between the terminals labeled ENERGY₁ andRETURN. A second signal of a second energy modality is coupled across acapacitor 910 and is provided to the surgical instrument between theterminals labeled ENERGY₂ and RETURN. It will be appreciated that morethan two energy modalities may be output and thus the subscript “n” maybe used to designate that up to n ENERGY_(n) terminals may be provided,where n is a positive integer greater than 1. It also will beappreciated that up to “n” return paths RETURN_(n) may be providedwithout departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY₁ and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY₂ and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 918. The outputs of the isolationtransformers 916, 928, 922 in the on the primary side of the powertransformer 908 (non-patient isolated side) are provided to a one ormore ADC circuit 926. The digitized output of the ADC circuit 926 isprovided to the processor 902 for further processing and computation.The output voltages and output current feedback information can beemployed to adjust the output voltage and current provided to thesurgical instrument and to compute output impedance, among otherparameters. Input/output communications between the processor 902 andpatient isolated circuits is provided through an interface circuit 920.Sensors also may be in electrical communication with the processor 902by way of the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY₁/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY₂/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY₁ may be ultrasonic energy and the second energy modality ENERGY₂may be RF energy. Nevertheless, in addition to ultrasonic and bipolar ormonopolar RF energy modalities, other energy modalities includeirreversible and/or reversible electroporation and/or microwave energy,among others. Also, although the example illustrated in FIG. 21 shows asingle return path RETURN may be provided for two or more energymodalities, in other aspects, multiple return paths RETURN_(n) may beprovided for each energy modality ENERGY_(n). Thus, as described herein,the ultrasonic transducer impedance may be measured by dividing theoutput of the first voltage sensing circuit 912 by the current sensingcircuit 914 and the tissue impedance may be measured by dividing theoutput of the second voltage sensing circuit 924 by the current sensingcircuit 914.

As shown in FIG. 21, the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. The connection of an ultrasonic transducer tothe generator 900 output would be preferably located between the outputlabeled ENERGY₁ and RETURN as shown in FIG. 21. In one example, aconnection of RF bipolar electrodes to the generator 900 output would bepreferably located between the output labeled ENERGY₂ and RETURN. In thecase of monopolar output, the preferred connections would be activeelectrode (e.g., pencil or other probe) to the ENERGY₂ output and asuitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

As used throughout this description, the term “wireless” and itsderivatives may be used to describe circuits, devices, systems, methods,techniques, communications channels, etc., that may communicate datathrough the use of modulated electromagnetic radiation through anon-solid medium. The term does not imply that the associated devices donot contain any wires, although in some aspects they might not. Thecommunication module may implement any of a number of wireless or wiredcommunication standards or protocols, including but not limited to Wi-Fi(IEEE 802.11 family), WMAX (IEEE 802.16 family), IEEE 802.20, long termevolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA,TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as anyother wireless and wired protocols that are designated as 3G, 4G, 5G,and beyond. The computing module may include a plurality ofcommunication modules. For instance, a first communication module may bededicated to shorter range wireless communications such as Wi-Fi andBluetooth and a second communication module may be dedicated to longerrange wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE,Ev-DO, and others.

As used herein a processor or processing unit is an electronic circuitwhich performs operations on some external data source, usually memoryor some other data stream. The term is used herein to refer to thecentral processor (central processing unit) in a system or computersystems (especially systems on a chip (SoCs)) that combine a number ofspecialized “processors.”

As used herein, a system on a chip or system on chip (SoC or SOC) is anintegrated circuit (also known as an “IC” or “chip”) that integrates allcomponents of a computer or other electronic systems. It may containdigital, analog, mixed-signal, and often radio-frequency functions—allon a single substrate. A SoC integrates a microcontroller (ormicroprocessor) with advanced peripherals like graphics processing unit(GPU), Wi-Fi module, or coprocessor. A SoC may or may not containbuilt-in memory.

As used herein, a microcontroller or controller is a system thatintegrates a microprocessor with peripheral circuits and memory. Amicrocontroller (or MCU for microcontroller unit) may be implemented asa small computer on a single integrated circuit. It may be similar to aSoC; a SoC may include a microcontroller as one of its components. Amicrocontroller may contain one or more core processing units (CPUs)along with memory and programmable input/output peripherals. Programmemory in the form of Ferroelectric RAM, NOR flash or OTP ROM is alsooften included on chip, as well as a small amount of RAM.Microcontrollers may be employed for embedded applications, in contrastto the microprocessors used in personal computers or other generalpurpose applications consisting of various discrete chips.

As used herein, the term controller or microcontroller may be astand-alone IC or chip device that interfaces with a peripheral device.This may be a link between two parts of a computer or a controller on anexternal device that manages the operation of (and connection with) thatdevice.

Any of the processors or microcontrollers described herein, may beimplemented by any single core or multicore processor such as thoseknown under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising on-chipmemory of 256 KB single-cycle flash memory, or other non-volatilememory, up to 40 MHz, a prefetch buffer to improve performance above 40MHz, a 32 KB single-cycle serial random access memory (SRAM), internalread-only memory (ROM) loaded with StellarisWare® software, 2 KBelectrically erasable programmable read-only memory (EEPROM), one ormore pulse width modulation (PWM) modules, one or more quadratureencoder inputs (QEI) analog, one or more 12-bit Analog-to-DigitalConverters (ADC) with 12 analog input channels, details of which areavailable for the product datasheet.

In one aspect, the processor may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

Modular devices include the modules (as described in connection withFIGS. 3 and 9, for example) that are receivable within a surgical huband the surgical devices or instruments that can be connected to thevarious modules in order to connect or pair with the correspondingsurgical hub. The modular devices include, for example, intelligentsurgical instruments, medical imaging devices, suction/irrigationdevices, smoke evacuators, energy generators, ventilators, insufflators,and displays. The modular devices described herein can be controlled bycontrol algorithms. The control algorithms can be executed on themodular device itself, on the surgical hub to which the particularmodular device is paired, or on both the modular device and the surgicalhub (e.g., via a distributed computing architecture). In someexemplifications, the modular devices' control algorithms control thedevices based on data sensed by the modular device itself (i.e., bysensors in, on, or connected to the modular device). This data can berelated to the patient being operated on (e.g., tissue properties orinsufflation pressure) or the modular device itself (e.g., the rate atwhich a knife is being advanced, motor current, or energy levels). Forexample, a control algorithm for a surgical stapling and cuttinginstrument can control the rate at which the instrument's motor drivesits knife through tissue according to resistance encountered by theknife as it advances.

FIG. 22 illustrates one form of a surgical system 1000 comprising agenerator 1100 and various surgical instruments 1104, 1106, 1108 usabletherewith, where the surgical instrument 1104 is an ultrasonic surgicalinstrument, the surgical instrument 1106 is an RF electrosurgicalinstrument, and the multifunction surgical instrument 1108 is acombination ultrasonic/RF electrosurgical instrument. The generator 1100is configurable for use with a variety of surgical instruments.According to various forms, the generator 1100 may be configurable foruse with different surgical instruments of different types including,for example, ultrasonic surgical instruments 1104, RF electrosurgicalinstruments 1106, and multifunction surgical instruments 1108 thatintegrate RF and ultrasonic energies delivered simultaneously from thegenerator 1100. Although in the form of FIG. 22 the generator 1100 isshown separate from the surgical instruments 1104, 1106, 1108 in oneform, the generator 1100 may be formed integrally with any of thesurgical instruments 1104, 1106, 1108 to form a unitary surgical system.The generator 1100 comprises an input device 1110 located on a frontpanel of the generator 1100 console. The input device 1110 may compriseany suitable device that generates signals suitable for programming theoperation of the generator 1100. The generator 1100 may be configuredfor wired or wireless communication.

The generator 1100 is configured to drive multiple surgical instruments1104, 1106, 1108. The first surgical instrument is an ultrasonicsurgical instrument 1104 and comprises a handpiece 1105 (HP), anultrasonic transducer 1120, a shaft 1126, and an end effector 1122. Theend effector 1122 comprises an ultrasonic blade 1128 acousticallycoupled to the ultrasonic transducer 1120 and a clamp arm 1140. Thehandpiece 1105 comprises a trigger 1143 to operate the clamp arm 1140and a combination of the toggle buttons 1134 a, 1134 b, 1134 c toenergize and drive the ultrasonic blade 1128 or other function. Thetoggle buttons 1134 a, 1134 b, 1134 c can be configured to energize theultrasonic transducer 1120 with the generator 1100.

The generator 1100 also is configured to drive a second surgicalinstrument 1106. The second surgical instrument 1106 is an RFelectrosurgical instrument and comprises a handpiece 1107 (HP), a shaft1127, and an end effector 1124. The end effector 1124 compriseselectrodes in clamp arms 1142 a, 1142 b and return through an electricalconductor portion of the shaft 1127. The electrodes are coupled to andenergized by a bipolar energy source within the generator 1100. Thehandpiece 1107 comprises a trigger 1145 to operate the clamp arms 1142a, 1142 b and an energy button 1135 to actuate an energy switch toenergize the electrodes in the end effector 1124.

The generator 1100 also is configured to drive a multifunction surgicalinstrument 1108. The multifunction surgical instrument 1108 comprises ahandpiece 1109 (HP), a shaft 1129, and an end effector 1125. The endeffector 1125 comprises an ultrasonic blade 1149 and a clamp arm 1146.The ultrasonic blade 1149 is acoustically coupled to the ultrasonictransducer 1120. The handpiece 1109 comprises a trigger 1147 to operatethe clamp arm 1146 and a combination of the toggle buttons 1137 a, 1137b, 1137 c to energize and drive the ultrasonic blade 1149 or otherfunction. The toggle buttons 1137 a, 1137 b, 1137 c can be configured toenergize the ultrasonic transducer 1120 with the generator 1100 andenergize the ultrasonic blade 1149 with a bipolar energy source alsocontained within the generator 1100.

The generator 1100 is configurable for use with a variety of surgicalinstruments. According to various forms, the generator 1100 may beconfigurable for use with different surgical instruments of differenttypes including, for example, the ultrasonic surgical instrument 1104,the RF electrosurgical instrument 1106, and the multifunction surgicalinstrument 1108 that integrates RF and ultrasonic energies deliveredsimultaneously from the generator 1100. Although in the form of FIG. 22the generator 1100 is shown separate from the surgical instruments 1104,1106, 1108, in another form the generator 1100 may be formed integrallywith any one of the surgical instruments 1104, 1106, 1108 to form aunitary surgical system. As discussed above, the generator 1100comprises an input device 1110 located on a front panel of the generator1100 console. The input device 1110 may comprise any suitable devicethat generates signals suitable for programming the operation of thegenerator 1100. The generator 1100 also may comprise one or more outputdevices 1112. Further aspects of generators for digitally generatingelectrical signal waveforms and surgical instruments are described in USpatent publication US-2017-0086914-A1, which is herein incorporated byreference in its entirety.

Situational Awareness

Although an “intelligent” device including control algorithms thatrespond to sensed data can be an improvement over a “dumb” device thatoperates without accounting for sensed data, some sensed data can beincomplete or inconclusive when considered in isolation, i.e., withoutthe context of the type of surgical procedure being performed or thetype of tissue that is being operated on. Without knowing the proceduralcontext (e.g., knowing the type of tissue being operated on or the typeof procedure being performed), the control algorithm may control themodular device incorrectly or suboptimally given the particularcontext-free sensed data. For example, the optimal manner for a controlalgorithm to control a surgical instrument in response to a particularsensed parameter can vary according to the particular tissue type beingoperated on. This is due to the fact that different tissue types havedifferent properties (e.g., resistance to tearing) and thus responddifferently to actions taken by surgical instruments. Therefore, it maybe desirable for a surgical instrument to take different actions evenwhen the same measurement for a particular parameter is sensed. As onespecific example, the optimal manner in which to control a surgicalstapling and cutting instrument in response to the instrument sensing anunexpectedly high force to close its end effector will vary dependingupon whether the tissue type is susceptible or resistant to tearing. Fortissues that are susceptible to tearing, such as lung tissue, theinstrument's control algorithm would optimally ramp down the motor inresponse to an unexpectedly high force to close to avoid tearing thetissue. For tissues that are resistant to tearing, such as stomachtissue, the instrument's control algorithm would optimally ramp up themotor in response to an unexpectedly high force to close to ensure thatthe end effector is clamped properly on the tissue. Without knowingwhether lung or stomach tissue has been clamped, the control algorithmmay make a suboptimal decision.

One solution utilizes a surgical hub including a system that isconfigured to derive information about the surgical procedure beingperformed based on data received from various data sources and thencontrol the paired modular devices accordingly. In other words, thesurgical hub is configured to infer information about the surgicalprocedure from received data and then control the modular devices pairedto the surgical hub based upon the inferred context of the surgicalprocedure. FIG. 23 illustrates a diagram of a situationally awaresurgical system 5100, in accordance with at least one aspect of thepresent disclosure. In some exemplifications, the data sources 5126include, for example, the modular devices 5102 (which can includesensors configured to detect parameters associated with the patientand/or the modular device itself), databases 5122 (e.g., an EMR databasecontaining patient records), and patient monitoring devices 5124 (e.g.,a blood pressure (BP) monitor and an electrocardiography (EKG) monitor).The surgical hub 5104 can be configured to derive the contextualinformation pertaining to the surgical procedure from the data basedupon, for example, the particular combination(s) of received data or theparticular order in which the data is received from the data sources5126. The contextual information inferred from the received data caninclude, for example, the type of surgical procedure being performed,the particular step of the surgical procedure that the surgeon isperforming, the type of tissue being operated on, or the body cavitythat is the subject of the procedure. This ability by some aspects ofthe surgical hub 5104 to derive or infer information related to thesurgical procedure from received data can be referred to as “situationalawareness.” In one exemplification, the surgical hub 5104 canincorporate a situational awareness system, which is the hardware and/orprogramming associated with the surgical hub 5104 that derivescontextual information pertaining to the surgical procedure from thereceived data.

The situational awareness system of the surgical hub 5104 can beconfigured to derive the contextual information from the data receivedfrom the data sources 5126 in a variety of different ways. In oneexemplification, the situational awareness system includes a patternrecognition system, or machine learning system (e.g., an artificialneural network), that has been trained on training data to correlatevarious inputs (e.g., data from databases 5122, patient monitoringdevices 5124, and/or modular devices 5102) to corresponding contextualinformation regarding a surgical procedure. In other words, a machinelearning system can be trained to accurately derive contextualinformation regarding a surgical procedure from the provided inputs. Inanother exemplification, the situational awareness system can include alookup table storing pre-characterized contextual information regardinga surgical procedure in association with one or more inputs (or rangesof inputs) corresponding to the contextual information. In response to aquery with one or more inputs, the lookup table can return thecorresponding contextual information for the situational awarenesssystem for controlling the modular devices 5102. In one exemplification,the contextual information received by the situational awareness systemof the surgical hub 5104 is associated with a particular controladjustment or set of control adjustments for one or more modular devices5102. In another exemplification, the situational awareness systemincludes a further machine learning system, lookup table, or other suchsystem, which generates or retrieves one or more control adjustments forone or more modular devices 5102 when provided the contextualinformation as input.

A surgical hub 5104 incorporating a situational awareness systemprovides a number of benefits for the surgical system 5100. One benefitincludes improving the interpretation of sensed and collected data,which would in turn improve the processing accuracy and/or the usage ofthe data during the course of a surgical procedure. To return to aprevious example, a situationally aware surgical hub 5104 coulddetermine what type of tissue was being operated on; therefore, when anunexpectedly high force to close the surgical instrument's end effectoris detected, the situationally aware surgical hub 5104 could correctlyramp up or ramp down the motor of the surgical instrument for the typeof tissue.

As another example, the type of tissue being operated can affect theadjustments that are made to the compression rate and load thresholds ofa surgical stapling and cutting instrument for a particular tissue gapmeasurement. A situationally aware surgical hub 5104 could infer whethera surgical procedure being performed is a thoracic or an abdominalprocedure, allowing the surgical hub 5104 to determine whether thetissue clamped by an end effector of the surgical stapling and cuttinginstrument is lung (for a thoracic procedure) or stomach (for anabdominal procedure) tissue. The surgical hub 5104 could then adjust thecompression rate and load thresholds of the surgical stapling andcutting instrument appropriately for the type of tissue.

As yet another example, the type of body cavity being operated in duringan insufflation procedure can affect the function of a smoke evacuator.A situationally aware surgical hub 5104 could determine whether thesurgical site is under pressure (by determining that the surgicalprocedure is utilizing insufflation) and determine the procedure type.As a procedure type is generally performed in a specific body cavity,the surgical hub 5104 could then control the motor rate of the smokeevacuator appropriately for the body cavity being operated in. Thus, asituationally aware surgical hub 5104 could provide a consistent amountof smoke evacuation for both thoracic and abdominal procedures.

As yet another example, the type of procedure being performed can affectthe optimal energy level for an ultrasonic surgical instrument or radiofrequency (RF) electrosurgical instrument to operate at. Arthroscopicprocedures, for example, require higher energy levels because the endeffector of the ultrasonic surgical instrument or RF electrosurgicalinstrument is immersed in fluid. A situationally aware surgical hub 5104could determine whether the surgical procedure is an arthroscopicprocedure. The surgical hub 5104 could then adjust the RF power level orthe ultrasonic amplitude of the generator (i.e., “energy level”) tocompensate for the fluid filled environment. Relatedly, the type oftissue being operated on can affect the optimal energy level for anultrasonic surgical instrument or RF electrosurgical instrument tooperate at. A situationally aware surgical hub 5104 could determine whattype of surgical procedure is being performed and then customize theenergy level for the ultrasonic surgical instrument or RFelectrosurgical instrument, respectively, according to the expectedtissue profile for the surgical procedure. Furthermore, a situationallyaware surgical hub 5104 can be configured to adjust the energy level forthe ultrasonic surgical instrument or RF electrosurgical instrumentthroughout the course of a surgical procedure, rather than just on aprocedure-by-procedure basis. A situationally aware surgical hub 5104could determine what step of the surgical procedure is being performedor will subsequently be performed and then update the control algorithmsfor the generator and/or ultrasonic surgical instrument or RFelectrosurgical instrument to set the energy level at a valueappropriate for the expected tissue type according to the surgicalprocedure step.

As yet another example, data can be drawn from additional data sources5126 to improve the conclusions that the surgical hub 5104 draws fromone data source 5126. A situationally aware surgical hub 5104 couldaugment data that it receives from the modular devices 5102 withcontextual information that it has built up regarding the surgicalprocedure from other data sources 5126. For example, a situationallyaware surgical hub 5104 can be configured to determine whetherhemostasis has occurred (i.e., whether bleeding at a surgical site hasstopped) according to video or image data received from a medicalimaging device. However, in some cases the video or image data can beinconclusive. Therefore, in one exemplification, the surgical hub 5104can be further configured to compare a physiologic measurement (e.g.,blood pressure sensed by a BP monitor communicably connected to thesurgical hub 5104) with the visual or image data of hemostasis (e.g.,from a medical imaging device 124 (FIG. 2) communicably coupled to thesurgical hub 5104) to make a determination on the integrity of thestaple line or tissue weld. In other words, the situational awarenesssystem of the surgical hub 5104 can consider the physiologicalmeasurement data to provide additional context in analyzing thevisualization data. The additional context can be useful when thevisualization data may be inconclusive or incomplete on its own.

Another benefit includes proactively and automatically controlling thepaired modular devices 5102 according to the particular step of thesurgical procedure that is being performed to reduce the number of timesthat medical personnel are required to interact with or control thesurgical system 5100 during the course of a surgical procedure. Forexample, a situationally aware surgical hub 5104 could proactivelyactivate the generator to which an RF electrosurgical instrument isconnected if it determines that a subsequent step of the procedurerequires the use of the instrument. Proactively activating the energysource allows the instrument to be ready for use a soon as the precedingstep of the procedure is completed.

As another example, a situationally aware surgical hub 5104 coulddetermine whether the current or subsequent step of the surgicalprocedure requires a different view or degree of magnification on thedisplay according to the feature(s) at the surgical site that thesurgeon is expected to need to view. The surgical hub 5104 could thenproactively change the displayed view (supplied by, e.g., a medicalimaging device for the visualization system 108) accordingly so that thedisplay automatically adjusts throughout the surgical procedure.

As yet another example, a situationally aware surgical hub 5104 coulddetermine which step of the surgical procedure is being performed orwill subsequently be performed and whether particular data orcomparisons between data will be required for that step of the surgicalprocedure. The surgical hub 5104 can be configured to automatically callup data screens based upon the step of the surgical procedure beingperformed, without waiting for the surgeon to ask for the particularinformation.

Another benefit includes checking for errors during the setup of thesurgical procedure or during the course of the surgical procedure. Forexample, a situationally aware surgical hub 5104 could determine whetherthe operating theater is setup properly or optimally for the surgicalprocedure to be performed. The surgical hub 5104 can be configured todetermine the type of surgical procedure being performed, retrieve thecorresponding checklists, product location, or setup needs (e.g., from amemory), and then compare the current operating theater layout to thestandard layout for the type of surgical procedure that the surgical hub5104 determines is being performed. In one exemplification, the surgicalhub 5104 can be configured to compare the list of items for theprocedure (scanned by a scanner, for example) and/or a list of devicespaired with the surgical hub 5104 to a recommended or anticipatedmanifest of items and/or devices for the given surgical procedure. Ifthere are any discontinuities between the lists, the surgical hub 5104can be configured to provide an alert indicating that a particularmodular device 5102, patient monitoring device 5124, and/or othersurgical item is missing. In one exemplification, the surgical hub 5104can be configured to determine the relative distance or position of themodular devices 5102 and patient monitoring devices 5124 via proximitysensors, for example. The surgical hub 5104 can compare the relativepositions of the devices to a recommended or anticipated layout for theparticular surgical procedure. If there are any discontinuities betweenthe layouts, the surgical hub 5104 can be configured to provide an alertindicating that the current layout for the surgical procedure deviatesfrom the recommended layout.

As another example, a situationally aware surgical hub 5104 coulddetermine whether the surgeon (or other medical personnel) was making anerror or otherwise deviating from the expected course of action duringthe course of a surgical procedure. For example, the surgical hub 5104can be configured to determine the type of surgical procedure beingperformed, retrieve the corresponding list of steps or order ofequipment usage (e.g., from a memory), and then compare the steps beingperformed or the equipment being used during the course of the surgicalprocedure to the expected steps or equipment for the type of surgicalprocedure that the surgical hub 5104 determined is being performed. Inone exemplification, the surgical hub 5104 can be configured to providean alert indicating that an unexpected action is being performed or anunexpected device is being utilized at the particular step in thesurgical procedure.

Overall, the situational awareness system for the surgical hub 5104improves surgical procedure outcomes by adjusting the surgicalinstruments (and other modular devices 5102) for the particular contextof each surgical procedure (such as adjusting to different tissue types)and validating actions during a surgical procedure. The situationalawareness system also improves surgeons' efficiency in performingsurgical procedures by automatically suggesting next steps, providingdata, and adjusting displays and other modular devices 5102 in thesurgical theater according to the specific context of the procedure.

Modular Energy System

ORs everywhere in the world are a tangled web of cords, devices, andpeople due to the amount of equipment required to perform surgicalprocedures. Surgical capital equipment tends to be a major contributorto this issue because most surgical capital equipment performs a single,specialized task. Due to their specialized nature and the surgeons'needs to utilize multiple different types of devices during the courseof a single surgical procedure, an OR may be forced to be stocked withtwo or even more pieces of surgical capital equipment, such as energygenerators. Each of these pieces of surgical capital equipment must beindividually plugged into a power source and may be connected to one ormore other devices that are being passed between OR personnel, creatinga tangle of cords that must be navigated. Another issue faced in modernORs is that each of these specialized pieces of surgical capitalequipment has its own user interface and must be independentlycontrolled from the other pieces of equipment within the OR. Thiscreates complexity in properly controlling multiple different devices inconnection with each other and forces users to be trained on andmemorize different types of user interfaces (which may further changebased upon the task or surgical procedure being performed, in additionto changing between each piece of capital equipment). This cumbersome,complex process can necessitate the need for even more individuals to bepresent within the OR and can create danger if multiple devices are notproperly controlled in tandem with each other. Therefore, consolidatingsurgical capital equipment technology into singular systems that areable to flexibly address surgeons' needs to reduce the footprint ofsurgical capital equipment within ORs would simplify the userexperience, reduce the amount of clutter in ORs, and preventdifficulties and dangers associated with simultaneously controllingmultiple pieces of capital equipment. Further, making such systemsexpandable or customizable would allow for new technology to beconveniently incorporated into existing surgical systems, obviating theneed to replace entire surgical systems or for OR personnel to learn newuser interfaces or equipment controls with each new technology.

As described in FIGS. 1-11, a surgical hub 106 can be configured tointerchangeably receive a variety of modules, which can in turninterface with surgical devices (e.g., a surgical instrument or a smokeevacuator) or provide various other functions (e.g., communications). Inone aspect, a surgical hub 106 can be embodied as a modular energysystem 2000, which is illustrated in connection with FIGS. 24-30. Themodular energy system 2000 can include a variety of different modules2001 that are connectable together in a stacked configuration. In oneaspect, the modules 2001 can be both physically and communicably coupledtogether when stacked or otherwise connected together into a singularassembly. Further, the modules 2001 can be interchangeably connectabletogether in different combinations or arrangements. In one aspect, eachof the modules 2001 can include a consistent or universal array ofconnectors disposed along their upper and lower surfaces, therebyallowing any module 2001 to be connected to another module 2001 in anyarrangement (except that, in some aspects, a particular module type,such as the header module 2002, can be configured to serve as theuppermost module within the stack, for example). In an alternativeaspect, the modular energy system 2000 can include a housing that isconfigured to receive and retain the modules 2001, as is shown in FIGS.3 and 4. The modular energy system 2000 can also include a variety ofdifferent components or accessories that are also connectable to orotherwise associatable with the modules 2001. In another aspect, themodular energy system 2000 can be embodied as a generator module 140,240 (FIGS. 3 and 10) of a surgical hub 106. In yet another aspect, themodular energy system 2000 can be a distinct system from a surgical hub106. In such aspects, the modular energy system 2000 can be communicablycouplable to a surgical hub 206 for transmitting and/or receiving datatherebetween.

The modular energy system 2000 can be assembled from a variety ofdifferent modules 2001, some examples of which are illustrated in FIG.24. Each of the different types of modules 2001 can provide differentfunctionality, thereby allowing the modular energy system 2000 to beassembled into different configurations to customize the functions andcapabilities of the modular energy system 2000 by customizing themodules 2001 that are included in each modular energy system 2000. Themodules 2001 of the modular energy system 2000 can include, for example,a header module 2002 (which can include a display screen 2006), anenergy module 2004, a technology module 2040, and a visualization module2042. In the depicted aspect, the header module 2002 is configured toserve as the top or uppermost module within the modular energy systemstack and can thus lack connectors along its top surface. In anotheraspect, the header module 2002 can be configured to be positioned at thebottom or the lowermost module within the modular energy system stackand can thus lack connectors along its bottom surface. In yet anotheraspect, the header module 2002 can be configured to be positioned at anintermediate position within the modular energy system stack and canthus include connectors along both its bottom and top surfaces. Theheader module 2002 can be configured to control the system-wide settingsof each module 2001 and component connected thereto through physicalcontrols 2011 thereon and/or a graphical user interface (GUI) 2008rendered on the display screen 2006. Such settings could include theactivation of the modular energy system 2000, the volume of alerts, thefootswitch settings, the settings icons, the appearance or configurationof the user interface, the surgeon profile logged into the modularenergy system 2000, and/or the type of surgical procedure beingperformed. The header module 2002 can also be configured to providecommunications, processing, and/or power for the modules 2001 that areconnected to the header module 2002. The energy module 2004, which canalso be referred to as a generator module 140, 240 (FIGS. 3 and 10), canbe configured to generate one or multiple energy modalities for drivingelectrosurgical and/or ultrasonic surgical instruments connectedthereto, such as is described above in connection with the generator 900illustrated in FIG. 21. The technology module 2040 can be configured toprovide additional or expanded control algorithms (e.g., electrosurgicalor ultrasonic control algorithms for controlling the energy output ofthe energy module 2004). The visualization module 2042 can be configuredto interface with visualization devices (i.e., scopes) and accordinglyprovide increased visualization capabilities.

The modular energy system 2000 can further include a variety ofaccessories 2029 that are connectable to the modules 2001 forcontrolling the functions thereof or that are otherwise configured towork on conjunction with the modular energy system 2000. The accessories2029 can include, for example, a single-pedal footswitch 2032, adual-pedal footswitch 2034, and a cart 2030 for supporting the modularenergy system 2000 thereon. The footswitches 2032, 2034 can beconfigured to control the activation or function of particular energymodalities output by the energy module 2004, for example.

By utilizing modular components, the depicted modular energy system 2000provides a surgical platform that grows with the availability oftechnology and is customizable to the needs of the facility and/orsurgeons. Further, the modular energy system 2000 supports combo devices(e.g., dual electrosurgical and ultrasonic energy generators) andsupports software-driven algorithms for customized tissue effects. Stillfurther, the surgical system architecture reduces the capital footprintby combining multiple technologies critical for surgery into a singlesystem.

The various modular components utilizable in connection with the modularenergy system 2000 can include monopolar energy generators, bipolarenergy generators, dual electrosurgical/ultrasonic energy generators,display screens, and various other modules and/or other components, someof which are also described above in connection with FIGS. 1-11.

Referring now to FIG. 25A, the header module 2002 can, in some aspects,include a display screen 2006 that renders a GUI 2008 for relayinginformation regarding the modules 2001 connected to the header module2002. In some aspects, the GUI 2008 of the display screen 2006 canprovide a consolidated point of control of all of the modules 2001making up the particular configuration of the modular energy system2000. Various aspects of the GUI 2008 are discussed in fuller detailbelow in connection with FIG. 30. In alternative aspects, the headermodule 2002 can lack the display screen 2006 or the display screen 2006can be detachably connected to the housing 2010 of the header module2002. In such aspects, the header module 2002 can be communicablycouplable to an external system that is configured to display theinformation generated by the modules 2001 of the modular energy system2000. For example, in robotic surgical applications, the modular energysystem 2000 can be communicably couplable to a robotic cart or roboticcontrol console, which is configured to display the informationgenerated by the modular energy system 2000 to the operator of therobotic surgical system. As another example, the modular energy system2000 can be communicably couplable to a mobile display that can becarried or secured to a surgical staff member for viewing thereby. Inyet another example, the modular energy system 2000 can be communicablycouplable to a surgical hub 2100 or another computer system that caninclude a display 2104, as is illustrated in FIG. 29. In aspectsutilizing a user interface that is separate from or otherwise distinctfrom the modular energy system 2000, the user interface can bewirelessly connectable with the modular energy system 2000 as a whole orone or more modules 2001 thereof such that the user interface candisplay information from the connected modules 2001 thereon.

Referring still to FIG. 25A, the energy module 2004 can include a portassembly 2012 including a number of different ports configured todeliver different energy modalities to corresponding surgicalinstruments that are connectable thereto. In the particular aspectillustrated in FIGS. 24-30, the port assembly 2012 includes a bipolarport 2014, a first monopolar port 2016 a, a second monopolar port 2018b, a neutral electrode port 2018 (to which a monopolar return pad isconnectable), and a combination energy port 2020. However, thisparticular combination of ports is simply provided for illustrativepurposes and alternative combinations of ports and/or energy modalitiesmay be possible for the port assembly 2012.

As noted above, the modular energy system 2000 can be assembled intodifferent configurations. Further, the different configurations of themodular energy system 2000 can also be utilizable for different surgicalprocedure types and/or different tasks. For example, FIGS. 25A and 25Billustrate a first illustrative configuration of the modular energysystem 2000 including a header module 2002 (including a display screen2006) and an energy module 2004 connected together. Such a configurationcan be suitable for laparoscopic and open surgical procedures, forexample.

FIG. 26A illustrates a second illustrative configuration of the modularenergy system 2000 including a header module 2002 (including a displayscreen 2006), a first energy module 2004 a, and a second energy module2004 b connected together. By stacking two energy modules 2004 a, 2004b, the modular energy system 2000 can provide a pair of port assemblies2012 a, 2012 b for expanding the array of energy modalities deliverableby the modular energy system 2000 from the first configuration. Thesecond configuration of the modular energy system 2000 can accordinglyaccommodate more than one bipolar/monopolar electrosurgical instrument,more than two bipolar/monopolar electrosurgical instruments, and so on.Such a configuration can be suitable for particularly complexlaparoscopic and open surgical procedures. FIG. 26B illustrates a thirdillustrative configuration that is similar to the second configuration,except that the header module 2002 lacks a display screen 2006. Thisconfiguration can be suitable for robotic surgical applications ormobile display applications, as noted above.

FIG. 27 illustrates a fourth illustrative configuration of the modularenergy system 2000 including a header module 2002 (including a displayscreen 2006), a first energy module 2004 a, a second energy module 2004b, and a technology module 2040 connected together. Such a configurationcan be suitable for surgical applications where particularly complex orcomputation-intensive control algorithms are required. Alternatively,the technology module 2040 can be a newly released module thatsupplements or expands the capabilities of previously released modules(such as the energy module 2004).

FIG. 28 illustrates a fifth illustrative configuration of the modularenergy system 2000 including a header module 2002 (including a displayscreen 2006), a first energy module 2004 a, a second energy module 2004b, a technology module 2040, and a visualization module 2042 connectedtogether. Such a configuration can be suitable for endoscopic proceduresby providing a dedicated surgical display 2044 for relaying the videofeed from the scope coupled to the visualization module 2042. It shouldbe noted that the configurations illustrated in FIGS. 25A-29 anddescribed above are provided simply to illustrate the various conceptsof the modular energy system 2000 and should not be interpreted to limitthe modular energy system 2000 to the particular aforementionedconfigurations.

As noted above, the modular energy system 2000 can be communicablycouplable to an external system, such as a surgical hub 2100 asillustrated in FIG. 29. Such external systems can include a displayscreen 2104 for displaying a visual feed from an endoscope (or a cameraor another such visualization device) and/or data from the modularenergy system 2000. Such external systems can also include a computersystem 2102 for performing calculations or otherwise analyzing datagenerated or provided by the modular energy system 2000, controlling thefunctions or modes of the modular energy system 2000, and/or relayingdata to a cloud computing system or another computer system. Suchexternal systems could also coordinate actions between multiple modularenergy systems 2000 and/or other surgical systems (e.g., a visualizationsystem 108 and/or a robotic system 110 as described in connection withFIGS. 1 and 2).

Referring now to FIG. 30, in some aspects, the header module 2002 caninclude or support a display 2006 configured for displaying a GUI 2008,as noted above. The display screen 2006 can include a touchscreen forreceiving input from users in addition to displaying information. Thecontrols displayed on the GUI 2008 can correspond to the module(s) 2001that are connected to the header module 2002. In some aspects, differentportions or areas of the GUI 2008 can correspond to particular modules2001. For example, a first portion or area of the GUI 2008 cancorrespond to a first module and a second portion or area of the GUI2008 can correspond to a second module. As different and/or additionalmodules 2001 are connected to the modular energy system stack, the GUI2008 can adjust to accommodate the different and/or additional controlsfor each newly added module 2001 or remove controls for each module 2001that is removed. Each portion of the display corresponding to aparticular module connected to the header module 2002 can displaycontrols, data, user prompts, and/or other information corresponding tothat module. For example, in FIG. 30, a first or upper portion 2052 ofthe depicted GUI 2008 displays controls and data associated with anenergy module 2004 that is connected to the header module 2002. Inparticular, the first portion 2052 of the GUI 2008 for the energy module2004 provides first widget 2056 a corresponding to the bipolar port2014, a second widget 2056 b corresponding to the first monopolar port2016 a, a third widget 2056 c corresponding to the second monopolar port2016 b, and a fourth widget 2056 d corresponding to the combinationenergy port 2020. Each of these widgets 2056 a-d provides data relatedto its corresponding port of the port assembly 2012 and controls forcontrolling the modes and other features of the energy modalitydelivered by the energy module 2004 through the respective port of theport assembly 2012. For example, the widgets 2056 a-d can be configuredto display the power level of the surgical instrument connected to therespective port, change the operational mode of the surgical instrumentconnected to the respective port (e.g., change a surgical instrumentfrom a first power level to a second power level and/or change amonopolar surgical instrument from a “spray” mode to a “blend” mode),and so on.

In one aspect, the header module 2002 can include various physicalcontrols 2011 in addition to or in lieu of the GUI 2008. Such physicalcontrols 2011 can include, for example, a power button that controls theactivation of each module 2001 that is connected to the header module2002 in the modular energy system 2000. Alternatively, the power buttoncan be displayed as part of the GUI 2008. Therefore, the header module2002 can serve as a single point of contact and obviate the need toindividually activate and deactivate each individual module 2001 fromwhich the modular energy system 2000 is constructed.

In one aspect, the header module 2002 can display still images, videos,animations, and/or information associated with the surgical modules 2001of which the modular energy system 2000 is constructed or the surgicaldevices that are communicably coupled to the modular energy system 2000.The still images and/or videos displayed by the header module 2002 canbe received from an endoscope or another visualization device that iscommunicably coupled to the modular energy system 2000. The animationsand/or information of the GUI 2008 can be overlaid on or displayedadjacent to the images or video feed.

In one aspect, the modules 2001 other than the header module 2002 can beconfigured to likewise relay information to users. For example, theenergy module 2004 can include light assemblies 2015 disposed about eachof the ports of the port assembly 2012. The light assemblies 2015 can beconfigured to relay information to the user regarding the port accordingto their color or state (e.g., flashing). For example, the lightassemblies 2015 can change from a first color to a second color when aplug is fully seated within the respective port. In one aspect, thecolor or state of the light assemblies 2015 can be controlled by theheader module 2002. For example, the header module 2002 can cause thelight assembly 2015 of each port to display a color corresponding to thecolor display for the port on the GUI 2008.

FIG. 31 is a block diagram of a stand-alone hub configuration of amodular energy system 3000, in accordance with at least one aspect ofthe present disclosure and FIG. 32 is a block diagram of a hubconfiguration of a modular energy system 3000 integrated with a surgicalcontrol system 3010, in accordance with at least one aspect of thepresent disclosure. As depicted in FIGS. 31 and 32, the modular energysystem 3000 can be either utilized as stand-alone units or integratedwith a surgical control system 3010 that controls and/or receives datafrom one or more surgical hub units. In the examples illustrated inFIGS. 31 and 32, the integrated header/UI module 3002 of the modularenergy system 3000 includes a header module and a UI module integratedtogether as a singular module. In other aspects, the header module andthe UI module can be provided as separate components that arecommunicatively coupled though a data bus 3008.

As illustrated in FIG. 31, an example of a stand-alone modular energysystem 3000 includes an integrated header module/user interface (UI)module 3002 coupled to an energy module 3004. Power and data aretransmitted between the integrated header/UI module 3002 and the energymodule 3004 through a power interface 3006 and a data interface 3008.For example, the integrated header/UI module 3002 can transmit variouscommands to the energy module 3004 through the data interface 3008. Suchcommands can be based on user inputs from the UI. As a further example,power may be transmitted to the energy module 3004 through the powerinterface 3006.

In FIG. 32, a surgical hub configuration includes a modular energysystem 3000 integrated with a control system 3010 and an interfacesystem 3022 for managing, among other things, data and powertransmission to and/or from the modular energy system 3000. The modularenergy system depicted in FIG. 32 includes an integrated headermodule/UI module 3002, a first energy module 3004, and a second energymodule 3012. In one example, a data transmission pathway is establishedbetween the system control unit 3024 of the control system 3010 and thesecond energy module 3012 through the first energy module 3004 and theheader/UI module 3002 through a data interface 3008. In addition, apower pathway extends between the integrated header/UI module 3002 andthe second energy module 3012 through the first energy module 3004through a power interface 3006. In other words, in one aspect, the firstenergy module 3004 is configured to function as a power and datainterface between the second energy module 3012 and the integratedheader/UI module 3002 through the power interface 3006 and the datainterface 3008. This arrangement allows the modular energy system 3000to expand by seamlessly connecting additional energy modules to energymodules 3004, 3012 that are already connected to the integratedheader/UI module 3002 without the need for dedicated power and energyinterfaces within the integrated header/UI module 3002.

The system control unit 3024, which may be referred to herein as acontrol circuit, control logic, microprocessor, microcontroller, logic,or FPGA, or various combinations thereof, is coupled to the systeminterface 3022 via energy interface 3026 and instrument communicationinterface 3028. The system interface 3022 is coupled to the first energymodule 3004 via a first energy interface 3014 and a first instrumentcommunication interface 3016. The system interface 3022 is coupled tothe second energy module 3012 via a second energy interface 3018 and asecond instrument communication interface 3020. As additional modules,such as additional energy modules, are stacked in the modular energysystem 3000, additional energy and communications interfaces areprovided between the system interface 3022 and the additional modules.

As described in more detail hereinbelow, the energy modules 3004, 3012are connectable to a hub and can be configured to generateelectrosurgical energy (e.g., bipolar or monopolar), ultrasonic energy,or a combination thereof (referred to herein as an “advanced energy”module) for a variety of energy surgical instruments. Generally, theenergy modules 3004, 3012 include hardware/software interfaces, anultrasonic controller, an advanced energy RF controller, bipolar RFcontroller, and control algorithms executed by the controller thatreceives outputs from the controller and controls the operation of thevarious energy modules 3004, 3012 accordingly. In various aspects of thepresent disclosure, the controllers described herein may be implementedas a control circuit, control logic, microprocessor, microcontroller,logic, or FPGA, or various combinations thereof.

FIGS. 33-35 are block diagrams of various modular energy systemsconnected together to form a hub, in accordance with at least one aspectof the present disclosure. FIGS. 33-35 depict various diagrams (e.g.,circuit or control diagrams) of hub modules. The modular energy system3000 includes multiple energy modules 3004 (FIG. 34), 3012 (FIG. 35), aheader module 3150 (FIG. 35), a UI module 3030 (FIG. 33), and acommunications module 3032 (FIG. 33), in accordance with at least oneaspect of the present disclosure. The UI module 3030 includes a touchscreen 3046 displaying various relevant information and various usercontrols for controlling one or more parameters of the modular energysystem 3000. The UI module 3030 is attached to the top header module3150, but is separately housed so that it can be manipulatedindependently of the header module 3150. For example, the UI module 3030can be picked up by a user and/or reattached to the header module 3150.Additionally, or alternatively, the UI module 3030 can be slightly movedrelative to the header module 3150 to adjust its position and/ororientation. For example, the UI module 3030 can be tilted and/orrotated relative to the header module 3150.

In some aspects, the various hub modules can include light piping aroundthe physical ports to communicate instrument status and also connecton-screen elements to corresponding instruments. Light piping is oneexample of an illumination technique that may be employed to alert auser to a status of a surgical instrument attached/connected to aphysical port. In one aspect, illuminating a physical port with aparticular light directs a user to connect a surgical instrument to thephysical port. In another example, illuminating a physical port with aparticular light alerts a user to an error related an existingconnection with a surgical instrument.

Turning to FIG. 33, there is shown a block diagram of a user interface(UI) module 3030 coupled to a communications module 3032 via apass-through hub connector 3034, in accordance with at least one aspectof the present disclosure. The UI module 3030 is provided as a separatecomponent from a header module 3150 (shown in FIG. 35) and may becommunicatively coupled to the header module 3150 via a communicationsmodule 3032, for example. In one aspect, the UI module 3030 can includea UI processor 3040 that is configured to represent declarativevisualizations and behaviors received from other connected modules, aswell as perform other centralized UI functionality, such as systemconfiguration (e.g., language selection, module associations, etc.). TheUI processor 3040 can be, for example, a processor or system on module(SOM) running a framework such as Qt, .NET WPF, Web server, or similar.

In the illustrated example, the UI module 3030 includes a touchscreen3046, a liquid crystal display 3048 (LCD), and audio output 3052 (e.g.,speaker, buzzer). The UI processor 3040 is configured to receivetouchscreen inputs from a touch controller 3044 coupled between thetouch screen 3046 and the UI processor 3040. The UI processor 3040 isconfigured to output visual information to the LCD display 3048 and tooutput audio information the audio output 3052 via an audio amplifier3050. The UI processor 3040 is configured to interface to thecommunications module 3032 via a switch 3042 coupled to the pass-throughhub connector 3034 to receive, process, and forward data from the sourcedevice to the destination device and control data communicationtherebetween. DC power is supplied to the UI module 3030 via DC/DCconverter modules 3054. The DC power is passed through the pass-throughhub connector 3034 to the communications module 3032 through the powerbus 3006. Data is passed through the pass-through hub connector 3034 tothe communications module 3032 through the data bus 3008. Switches 3042,3056 receive, process, and forward data from the source device to thedestination device.

Continuing with FIG. 33, the communications module 3032, as well asvarious surgical hubs and/or surgical systems can include a gateway 3058that is configured to shuttle select traffic (i.e., data) between twodisparate networks (e.g., an internal network and/or a hospital network)that are running different protocols. The communications module 3032includes a first pass-through hub connector 3036 to couple thecommunications module 3032 to other modules. In the illustrated example,the communications module 3032 is coupled to the UI module 3030. Thecommunications module 3032 is configured to couple to other modules(e.g., energy modules) via a second pass-through hub connector 3038 tocouple the communications module 3032 to other modules via a switch 3056disposed between the first and second pass-through hub connectors 3036,3038 to receive, process, and forward data from the source device to thedestination device and control data communication therebetween. Theswitch 3056 also is coupled to a gateway 3058 to communicate informationbetween external communications ports and the UI module 3030 and otherconnected modules. The gateway 3058 may be coupled to variouscommunications modules such as, for example, an Ethernet module 3060 tocommunicate to a hospital or other local network, a universal serial bus(USB) module 3062, a WiFi module 3064, and a Bluetooth module 3066,among others. The communications modules may be physical boards locatedwithin the communications module 3032 or may be a port to couple toremote communications boards.

In some aspects, all of the modules (i.e., detachable hardware) arecontrolled by a single UI module 3030 that is disposed on or integral toa header module. FIG. 35 shows a stand alone header module 3150 to whichthe UI module 3030 can be attached. FIGS. 31, 32, and 36 show anintegrated header/UI Module 3002. Returning now to FIG. 33, in variousaspects, by consolidating all of the modules into a single, responsiveUI module 3002, the system provides a simpler way to control and monitormultiple pieces of equipment at once. This approach drastically reducesfootprint and complexity in an operating room (OR).

Turning to FIG. 34, there is shown a block diagram of an energy module3004, in accordance with at least one aspect of the present disclosure.The communications module 3032 (FIG. 33) is coupled to the energy module3004 via the second pass-through hub connector 3038 of thecommunications module 3032 and a first pass-through hub connector 3074of the energy module 3004. The energy module 3004 may be coupled toother modules, such as a second energy module 3012 shown in FIG. 35, viaa second pass-through hub connector 3078. Turning back to FIG. 34, aswitch 3076 disposed between the first and second pass-through hubconnectors 3074, 3078 receives, processes, and forwards data from thesource device to the destination device and controls data communicationtherebetween. Data is received and transmitted through the data bus3008. The energy module 3032 includes a controller 3082 to controlvarious communications and processing functions of the energy module3004.

DC power is received and transmitted by the energy module 3004 throughthe power bus 3006. The power bus 3006 is coupled to DC/DC convertermodules 3138 to supply power to adjustable regulators 3084, 3107 andisolated DC/DC converter ports 3096, 3112, 3132.

In one aspect, the energy module 3004 can include an ultrasonic widebandamplifier 3086, which in one aspect may be a linear class H amplifierthat is capable of generating arbitrary waveforms and drive harmonictransducers at low total harmonic distortion (THD) levels. Theultrasonic wideband amplifier 3086 is fed by a buck adjustable regulator3084 to maximize efficiency and controlled by the controller 3082, whichmay be implemented as a digital signal processor (DSP) via a directdigital synthesizer (DDS), for example. The DDS can either be embeddedin the DSP or implemented in the field-programmable gate array (FPGA),for example. The controller 3082 controls the ultrasonic widebandamplifier 3086 via a digital-to-analog converter 3106 (DAC). The outputof the ultrasonic wideband amplifier 3086 is fed to an ultrasonic powertransformer 3088, which is coupled to an ultrasonic energy outputportion of an advanced energy receptacle 3100. Ultrasonic voltage (V)and current (I) feedback (FB) signals, which may be employed to computeultrasonic impedance, are fed back to the controller 3082 via anultrasonic VI FB transformer 3092 through an input portion of theadvanced energy receptacle 3100. The ultrasonic voltage and currentfeedback signals are routed back to the controller 3082 through ananalog-to-digital converter 3102 (A/D). Also coupled to the controller3082 through the advanced energy receptacle 3100 is the isolated DC/DCconverter port 3096, which receives DC power from the power bus 3006,and a medium bandwidth data port 3098.

In one aspect, the energy module 3004 can include a wideband RF poweramplifier 3108, which in one aspect may be a linear class H amplifierthat is capable of generating arbitrary waveforms and drive RF loads ata range of output frequencies. The wideband RF power amplifier 3108 isfed by an adjustable buck regulator 3107 to maximize efficiency andcontrolled by the controller 3082, which may be implemented as DSP via aDDS. The DDS can either be embedded in the DSP or implemented in theFPGA, for example. The controller 3082 controls the wideband RFamplifier 3086 via a DAC 3122. The output of the wideband RF poweramplifier 3108 can be fed through RF selection relays 3124. The RFselection relays 3124 are configured to receive and selectively transmitthe output signal of the wideband RF power amplifier 3108 to variousother components of the energy module 3004. In one aspect, the outputsignal of the wideband RF power amplifier 3108 can be fed through RFselection relays 3124 to an RF power transformer 3110, which is coupledto an RF output portion of a bipolar RF energy receptacle 3118. BipolarRF voltage (V) and current (I) feedback (FB) signals, which may beemployed to compute RF impedance, are fed back to the controller 3082via an RF VI FB transformer 3114 through an input portion of the bipolarRF energy receptacle 3118. The RF voltage and current feedback signalsare routed back to the controller 3082 through an A/D 3120. Also coupledto the controller 3082 through the bipolar RF energy receptacle 3118 isthe isolated DC/DC converter port 3112, which receives DC power from thepower bus 3006, and a low bandwidth data port 3116.

As described above, in one aspect, the energy module 3004 can include RFselection relays 3124 driven by the controller 3082 (e.g., FPGA) atrated coil current for actuation and can also be set to a lowerhold-current via pulse-width modulation (PWM) to limit steady-statepower dissipation. Switching of the RF selection relays 3124 is achievedwith force guided (safety) relays and the status of the contact state issensed by the controller 3082 as a mitigation for any single faultconditions. In one aspect, the RF selection relays 3124 are configuredto be in a first state, where an output RF signal received from an RFsource, such as the wideband RF power amplifier 3108, is transmitted toa first component of the energy module 3004, such as the RF powertransformer 3110 of the bipolar energy receptacle 3118. In a secondaspect, the RF selection relays 3124 are configured to be in a secondstate, where an output RF signal received from an RF source, such as thewideband RF power amplifier 3108, is transmitted to a second component,such as an RF power transformer 3128 of a monopolar energy receptacle3136, described in more detail below. In a general aspect, the RFselection relays 3124 are configured to be driven by the controller 3082to switch between a plurality of states, such as the first state and thesecond state, to transmit the output RF signal received from the RFpower amplifier 3108 between different energy receptacles of the energymodule 3004.

As described above, the output of the wideband RF power amplifier 3108can also fed through the RF selection relays 3124 to the wideband RFpower transformer 3128 of the RF monopolar receptacle 3136. Monopolar RFvoltage (V) and current (I) feedback (FB) signals, which may be employedto compute RF impedance, are fed back to the controller 3082 via an RFVI FB transformer 3130 through an input portion of the monopolar RFenergy receptacle 3136. The RF voltage and current feedback signals arerouted back to the controller 3082 through an A/D 3126. Also coupled tothe controller 3082 through the monopolar RF energy receptacle 3136 isthe isolated DC/DC converter port 3132, which receives DC power from thepower bus 3006, and a low bandwidth data port 3134.

The output of the wideband RF power amplifier 3108 can also fed throughthe RF selection relays 3124 to the wideband RF power transformer 3090of the advanced energy receptacle 3100. RF voltage (V) and current (I)feedback (FB) signals, which may be employed to compute RF impedance,are fed back to the controller 3082 via an RF VI FB transformer 3094through an input portion of the advanced energy receptacle 3100. The RFvoltage and current feedback signals are routed back to the controller3082 through an A/D 3104.

FIG. 35 is a block diagram of a second energy module 3012 coupled to aheader module 3150, in accordance with at least one aspect of thepresent disclosure. The first energy module 3004 shown in FIG. 34 iscoupled to the second energy module 3012 shown in FIG. 35 by couplingthe second pass-through hub connector 3078 of the first energy module3004 to a first pass-through hub connector 3074 of the second energymodule 3012. In one aspect, the second energy module 3012 can a similarenergy module to the first energy module 3004, as is illustrated in FIG.35. In another aspect, the second energy module 2012 can be a differentenergy module compared to the first energy module, such as an energymodule illustrated in FIG. 37, described in more detail. The addition ofthe second energy module 3012 to the first energy module 3004 addsfunctionality to the modular energy system 3000.

The second energy module 3012 is coupled to the header module 3150 byconnecting the pass-through hub connector 3078 to the pass-through hubconnector 3152 of the header module 3150. In one aspect, the headermodule 3150 can include a header processor 3158 that is configured tomanage a power button function 3166, software upgrades through theupgrade USB module 3162, system time management, and gateway to externalnetworks (i.e., hospital or the cloud) via an Ethernet module 3164 thatmay be running different protocols. Data is received by the headermodule 3150 through the pass-through hub connector 3152. The headerprocessor 3158 also is coupled to a switch 3160 to receive, process, andforward data from the source device to the destination device andcontrol data communication therebetween. The header processor 3158 alsois coupled to an OTS power supply 3156 coupled to a mains power entrymodule 3154.

FIG. 36 is a block diagram of a header/user interface (UI) module 3002for a hub, such as the header module depicted in FIG. 33, in accordancewith at least one aspect of the present disclosure. The header/UI module3002 includes a header power module 3172, a header wireless module 3174,a header USB module 3176, a header audio/screen module 3178, a headernetwork module 3180 (e.g., Ethernet), a backplane connector 3182, aheader standby processor module 3184, and a header footswitch module3186. These functional modules interact to provide the header/UI 3002functionality. A header/UI controller 3170 controls each of thefunctional modules and the communication therebetween including safetycritical control logic modules 3230, 3232 coupled between the header/UIcontroller 3170 and an isolated communications module 3234 coupled tothe header footswitch module 3186. A security coprocessor 3188 iscoupled to the header/UI controller 3170.

The header power module 3172 includes a mains power entry module 3190coupled to an OTS power supply unit 3192 (PSU). Low voltage directcurrent (e.g., 5V) standby power is supplied to the header/UI module3002 and other modules through a low voltage power bus 3198 from the OTSPSU 3192. High voltage direct current (e.g., 60V) is supplied to theheader/UI module 3002 through a high voltage bus 3200 from the OTS PSU3192. The high voltage DC supplies DC/DC converter modules 3196 as wellas isolated DC/DC converter modules 3236. A standby processor 3204 ofthe header/standby module 3184 provides a PSU/enable signal 3202 to theOTS PSU 3192.

The header wireless module 3174 includes a WiFi module 3212 and aBluetooth module 3214. Both the WiFi module 3212 and the Bluetoothmodule 3214 are coupled to the header/UI controller 3170. The Bluetoothmodule 3214 is used to connect devices without using cables and theWi-Fi module 3212 provides high-speed access to networks such as theInternet and can be employed to create a wireless network that can linkmultiple devices such as, for examples, multiple energy modules or othermodules and surgical instruments, among other devices located in theoperating room. Bluetooth is a wireless technology standard that is usedto exchange data over short distances, such as, less than 30 feet.

The header USB module 3176 includes a USB port 3216 coupled to theheader/UI controller 3170. The USB module 3176 provides a standard cableconnection interface for modules and other electronics devices overshort-distance digital data communications. The USB module 3176 allowsmodules comprising USB devices to be connected to each other with andtransfer digital data over USB cables.

The header audio/screen module 3178 includes a touchscreen 3220 coupledto a touch controller 3218. The touch controller 3218 is coupled to theheader/UI controller 3170 to read inputs from the touchscreen 3220. Theheader/UI controller 3170 drives an LCD display 3224 through adisplay/port video output signal 3222. The header/UI controller 3170 iscoupled to an audio amplifier 3226 to drive one or more speakers 3228.

In one aspect, the header/UI module 3002 provides a touchscreen 3220user interface configured to control modules connected to one control orheader module 3002 in a modular energy system 3000. The touchscreen 3220can be used to maintain a single point of access for the user to adjustall modules connected within the modular energy system 3000. Additionalhardware modules (e.g., a smoke evacuation module) can appear at thebottom of the user interface LCD display 3224 when they become connectedto the header/UI module 3002, and can disappear from the user interfaceLCD display 3224 when they are disconnected from the header/UI module3002.

Further, the user touchscreen 3220 can provide access to the settings ofmodules attached to the modular energy system 3000. Further, the userinterface LCD display 3224 arrangement can be configured to changeaccording to the number and types of modules that are connected to theheader/UI module 3002. For example, a first user interface can bedisplayed on the LCD display 3224 for a first application where oneenergy module and one smoke evacuation module are connected to theheader/UI module 3002, and a second user interface can be displayed onthe LCD display 3224 for a second application where two energy modulesare connected to the header/UI module 3002. Further, the user interfacecan alter its display on the LCD display 3224 as modules are connectedand disconnected from the modular energy system 3000.

In one aspect, the header/UI module 3002 provides a user interface LCDdisplay 3224 configured to display on the LCD display coloringcorresponds to the port lighting. In one aspect, the coloring of theinstrument panel and the LED light around its corresponding port will bethe same or otherwise correspond with each other. Each color can, forexample, convey a unique meaning. This way, the user will be able toquickly assess which instrument the indication is referring to and thenature of the indication. Further, indications regarding an instrumentcan be represented by the changing of color of the LED light linedaround its corresponding port and the coloring of its module. Stillfurther, the message on screen and hardware/software port alignment canalso serve to convey that an action must be taken on the hardware, noton the interface. In various aspects, all other instruments can be usedwhile alerts are occurring on other instruments. This allows the user tobe able to quickly assess which instrument the indication is referringto and the nature of the indication.

In one aspect, the header/UI module 3002 provides a user interfacescreen configured to display on the LCD display 3224 to presentprocedure options to a user. In one aspect, the user interface can beconfigured to present the user with a series of options (which can bearranged, e.g., from broad to specific). After each selection is made,the modular energy system 3000 presents the next level until allselections are complete. These settings could be managed locally andtransferred via a secondary means (such as a USB thumb drive).Alternatively, the settings could be managed via a portal andautomatically distributed to all connected systems in the hospital.

The procedure options can include, for example, a list of factory presetoptions categorized by specialty, procedure, and type of procedure. Uponcompleting a user selection, the header module can be configured to setany connected instruments to factory-preset settings for that specificprocedure. The procedure options can also include, for example, a listof surgeons, then subsequently, the specialty, procedure, and type. Oncea user completes a selection, the system may suggest the surgeon'spreferred instruments and set those instrument's settings according tothe surgeon's preference (i.e., a profile associated with each surgeonstoring the surgeon's preferences).

In one aspect, the header/UI module 3002 provides a user interfacescreen configured to display on the LCD display 3224 critical instrumentsettings. In one aspect, each instrument panel displayed on the LCDdisplay 3224 of the user interface corresponds, in placement andcontent, to the instruments plugged into the modular energy system 3000.When a user taps on a panel, it can expand to reveal additional settingsand options for that specific instrument and the rest of the screen can,for example, darken or otherwise be de-emphasized.

In one aspect, the header/UI module 3002 provides an instrument settingspanel of the user interface configured to comprise/display controls thatare unique to an instrument and allow the user to increase or decreasethe intensity of its output, toggle certain functions, pair it withsystem accessories like a footswitch connected to header footswitchmodule 3186, access advanced instrument settings, and find additionalinformation about the instrument. In one aspect, the user can tap/selectan “Advanced Settings” control to expand the advanced settings drawerdisplayed on the user interface LCD display 3224. In one aspect, theuser can then tap/select an icon at the top right-hand corner of theinstrument settings panel or tap anywhere outside of the panel and thepanel will scale back down to its original state. In these aspects, theuser interface is configured to display on the LCD display 3224 only themost critical instrument settings, such as power level and power mode,on the ready/home screen for each instrument panel. This is to maximizethe size and readability of the system from a distance. In some aspects,the panels and the settings within can be scaled proportionally to thenumber of instruments connected to the system to further improvereadability. As more instruments are connected, the panels scale toaccommodate a greater amount of information.

The header network module 3180 includes a plurality of networkinterfaces 3264, 3266, 3268 (e.g., Ethernet) to network the header/UImodule 3002 to other modules of the modular energy system 3000. In theillustrated example, one network interface 3264 may be a 3rd partynetwork interface, another network interface 3266 may be a hospitalnetwork interface, and yet another network interface 3268 may be locatedon the backplane network interface connector 3182.

The header standby processor module 3184 includes a standby processor3204 coupled to an On/Off switch 3210. The standby processor 3204conducts an electrical continuity test by checking to see if electricalcurrent flows in a continuity loop 3206. The continuity test isperformed by placing a small voltage across the continuity loop 3206. Aserial bus 3208 couples the standby processor 3204 to the backplaneconnector 3182.

The header footswitch module 3186 includes a controller 3240 coupled toa plurality of analog footswitch ports 3254, 3256, 3258 through aplurality of corresponding presence/ID and switch state modules 3242,3244, 3246, respectively. The controller 3240 also is coupled to anaccessory port 3260 via a presence/ID and switch state module 3248 and atransceiver module 3250. The accessory port 3260 is powered by anaccessory power module 3252. The controller 3240 is coupled to header/UIcontroller 3170 via an isolated communication module 3234 and first andsecond safety critical control modules 3230, 3232. The header footswitchmodule 3186 also includes DC/DC converter modules 3238.

In one aspect, the header/UI module 3002 provides a user interfacescreen configured to display on the LCD display 3224 for controlling afootswitch connected to any one of the analog footswitch ports 3254,3256, 3258. In some aspects, when the user plugs in a non hand-activatedinstrument into any one of the analog footswitch ports 3254, 3256, 3258,the instrument panel appears with a warning icon next to the footswitchicon. The instrument settings can be, for example, greyed out, as theinstrument cannot be activated without a footswitch.

When the user plugs in a footswitch into any one of the analogfootswitch ports 3254, 3256, 3258, a pop-up appears indicating that afootswitch has been assigned to that instrument. The footswitch iconindicates that a footswitch has been plugged in and assigned to theinstrument. The user can then tap/select on that icon to assign,reassign, unassign, or otherwise change the settings associated withthat footswitch. In these aspects, the system is configured toautomatically assign footswitches to non hand-activated instrumentsusing logic, which can further assign single or double-pedalfootswitches to the appropriate instrument. If the user wants toassign/reassign footswitches manually there are two flows that can beutilized.

In one aspect, the header/UI module 3002 provides a global footswitchbutton. Once the user taps on the global footswitch icon (located in theupper right of the user interface LCD display 3224), the footswitchassignment overlay appears and the contents in the instrument modulesdim. A (e.g., photo-realistic) representation of each attachedfootswitch (dual or single-pedal) appears on the bottom if unassigned toan instrument or on the corresponding instrument panel. Accordingly, theuser can drag and drop these illustrations into, and out of, the boxedicons in the footswitch assignment overlay to assign, unassign, andreassign footswitches to their respective instruments.

In one aspect, the header/UI module 3002 provides a user interfacescreen displayed on the LCD display 3224 indicating footswitchauto-assignment, in accordance with at least one aspect of the presentdisclosure. As discussed above, the modular energy system 3000 can beconfigured to auto-assign a footswitch to an instrument that does nothave hand activation. In some aspects, the header/UI module 3002 can beconfigured to correlate the colors displayed on the user interface LCDdisplay 3224 to the lights on the modules themselves as means oftracking physical ports with user interface elements.

In one aspect, the header/UI module 3002 may be configured to depictvarious applications of the user interface with differing number ofmodules connected to the modular energy system 3000. In various aspects,the overall layout or proportion of the user interface elementsdisplayed on the LCD display 3224 can be based on the number and type ofinstruments plugged into the header/UI module 3002. These scalablegraphics can provide the means to utilize more of the screen for bettervisualization.

In one aspect, the header/UI module 3002 may be configured to depict auser interface screen on the LCD display 3224 to indicate which ports ofthe modules connected to the modular energy system 3000 are active. Insome aspects, the header/UI module 3002 can be configured to illustrateactive versus inactive ports by highlighting active ports and dimminginactive ports. In one aspect, ports can be represented with color whenactive (e.g., monopolar tissue cut with yellow, monopolar tissuecoagulation with blue, bipolar tissue cut with blue, advanced energytissue cut with warm white, and so on). Further, the displayed colorwill match the color of the light piping around the ports. The coloringcan further indicate that the user cannot change settings of otherinstruments while an instrument is active. As another example, theheader/UI module 3002 can be configured to depict the bipolar,monopolar, and ultrasonic ports of a first energy module as active andthe monopolar ports of a second energy module as likewise active.

In one aspect, the header/UI module 3002 can be configured to depict auser interface screen on the LCD display 3224 to display a globalsettings menu. In one aspect, the header/UI module 3002 can beconfigured to display a menu on the LCD display 3224 to control globalsettings across any modules connected to the modular energy system 3000.The global settings menu can be, for example, always displayed in aconsistent location (e.g., always available in upper right hand cornerof main screen).

In one aspect, the header/UI module 3002 can be configured to depict auser interface screen on the LCD display 3224 configured to preventchanging of settings while a surgical instrument is in use. In oneexample, the header/UI module 3002 can be configured to prevent settingsfrom being changed via a displayed menu when a connected instrument isactive. The user interface screen can include, for example, an area(e.g., the upper left hand corner) that is reserved for indicatinginstrument activation while a settings menu is open. In one aspect, auser has opened the bipolar settings while monopolar coagulation isactive. In one aspect, the settings menu could then be used once theactivation is complete. In one aspect, the header/UI module 3002 can beis configured to never overlay any menus or other information over thededicated area for indicating critical instrument information in orderto maintain display of critical information.

In one aspect, the header/UI module 3002 can be configured to depict auser interface screen on the LCD display 3224 configured to displayinstrument errors. In one aspect, instrument error warnings may bedisplayed on the instrument panel itself, allowing user to continue touse other instruments while a nurse troubleshoots the error. This allowsusers to continue the surgery without the need to stop the surgery todebug the instrument.

In one aspect, the header/UI module 3002 can be configured to depict auser interface screen on the LCD display 3224 to display different modesor settings available for various instruments. In various aspects, theheader/UI module 3002 can be configured to display settings menus thatare appropriate for the type or application of surgical instrument(s)connected to the stack/hub. Each settings menu can provide options fordifferent power levels, energy delivery profiles, and so on that areappropriate for the particular instrument type. In one aspect, theheader/UI module 3002 can be configured to display different modesavailable for bipolar, monopolar cut, and monopolar coagulationapplications.

In one aspect, the header/UI module 3002 can be configured to depict auser interface screen on the LCD display 3224 to display pre-selectedsettings. In one aspect, the header/UI module 3002 can be configured toreceive selections for the instrument/device settings before plugging ininstruments so that the modular energy system 3000 is ready before thepatient enters the operating room. In one aspect, the user can simplyclick a port and then change the settings for that port. In the depictedaspect, the selected port appears as faded to indicate settings are set,but no instrument is plugged into that port.

FIG. 37 is a block diagram of an energy module 3270 for a hub, such asthe energy module depicted in FIGS. 31, 32, 34, and 35, in accordancewith at least one aspect of the present disclosure. The energy module3270 is configured to couple to a header module, header/UI module, andother energy modules via the first and second pass-through hubconnectors 3272, 3276. A switch 3076 disposed between the first andsecond pass-through hub connectors 3272, 3276 receives, processes, andforwards data from the source device to the destination device andcontrols data communication therebetween. Data is received andtransmitted through the data bus 3008. The energy module 3270 includes acontroller 3082 to control various communications and processingfunctions of the energy module 3270.

DC power is received and transmitted by the energy module 3270 throughthe power bus 3006. The power bus 3006 is coupled to the DC/DC convertermodules 3138 to supply power to adjustable regulators 3084, 3107 andisolated DC/DC converter ports 3096, 3112, 3132.

In one aspect, the energy module 3270 can include an ultrasonic widebandamplifier 3086, which in one aspect may be a linear class H amplifierthat is capable of generating arbitrary waveforms and drive harmonictransducers at low total harmonic distortion (THD) levels. Theultrasonic wideband amplifier 3086 is fed by a buck adjustable regulator3084 to maximize efficiency and controlled by the controller 3082, whichmay be implemented as a digital signal processor (DSP) via a directdigital synthesizer (DDS), for example. The DDS can either be embeddedin the DSP or implemented in the field-programmable gate array (FPGA),for example. The controller 3082 controls the ultrasonic widebandamplifier 3086 via a digital-to-analog converter 3106 (DAC). The outputof the ultrasonic wideband amplifier 3086 is fed to an ultrasonic powertransformer 3088, which is coupled to an ultrasonic energy outputportion of the advanced energy receptacle 3100. Ultrasonic voltage (V)and current (I) feedback (FB) signals, which may be employed to computeultrasonic impedance, are fed back to the controller 3082 via anultrasonic VI FB transformer 3092 through an input portion of theadvanced energy receptacle 3100. The ultrasonic voltage and currentfeedback signals are routed back to the controller 3082 through ananalog multiplexer 3280 and a dual analog-to-digital converter 3278(A/D). In one aspect, the dual A/D 3278 has a sampling rate of 80 MSPS.Also coupled to the controller 3082 through the advanced energyreceptacle 3100 is the isolated DC/DC converter port 3096, whichreceives DC power from the power bus 3006, and a medium bandwidth dataport 3098.

In one aspect, the energy module 3270 can include a plurality ofwideband RF power amplifiers 3108, 3286, 3288, among others, which inone aspect, each of the wideband RF power amplifiers 3108, 3286, 3288may be linear class H amplifiers capable of generating arbitrarywaveforms and drive RF loads at a range of output frequencies. Each ofthe wideband RF power amplifiers 3108, 3286, 3288 are fed by anadjustable buck regulator 3107 to maximize efficiency and controlled bythe controller 3082, which may be implemented as DSP via a DDS. The DDScan either be embedded in the DSP or implemented in the FPGA, forexample. The controller 3082 controls the first wideband RF poweramplifier 3108 via a DAC 3122.

Unlike the energy modules 3004, 3012 shown and described in FIGS. 34 and35, the energy module 3270 does not include RF selection relaysconfigured to receive an RF output signal from the adjustable buckregulator 3107. In addition, unlike the energy modules 3004, 3012 shownand described in FIGS. 34 and 35, the energy module 3270 includes aplurality of wideband RF power amplifiers 3108, 3286, 3288 instead of asingle RF power amplifier. In one aspect, the adjustable buck regulator3107 can switch between a plurality of states, in which the adjustablebuck regulator 3107 outputs an output RF signal to one of the pluralityof wideband RF power amplifiers 3108, 3286, 3288 connected thereto. Thecontroller 3082 is configured to switch the adjustable buck regulator3107 between the plurality of states. In a first state, the controllerdrives the adjustable buck regulator 3107 to output an RF energy signalto the first wideband RF power amplifier 3108. In a second state, thecontroller drives the adjustable buck regulator 3107 to output an RFenergy signal to the second wideband RF power amplifier 3286. In a thirdstate, the controller drives the adjustable buck regulator 3107 tooutput an RF energy signal to the third wideband RF power amplifier3288.

The output of the first wideband RF power amplifier 3108 can be fed toan RF power transformer 3090, which is coupled to an RF output portionof an advanced energy receptacle 3100. RF voltage (V) and current (I)feedback (FB) signals, which may be employed to compute RF impedance,are fed back to the controller 3082 via RF VI FB transformers 3094through an input portion of the advanced energy receptacle 3100. The RFvoltage and current feedback signals are routed back to the controller3082 through the RF VI FB transformers 3094, which are coupled to ananalog multiplexer 3284 and a dual A/D 3282 coupled to the controller3082. In one aspect, the dual A/D 3282 has a sampling rate of 80 MSPS.

The output of the second RF wideband power amplifier 3286 is fed throughan RF power transformer 3128 of the RF monopolar receptacle 3136.Monopolar RF voltage (V) and current (I) feedback (FB) signals, whichmay be employed to compute RF impedance, are fed back to the controller3082 via RF VI FB transformers 3130 through an input portion of themonopolar RF energy receptacle 3136. The RF voltage and current feedbacksignals are routed back to the controller 3082 through the analogmultiplexer 3284 and the dual A/D 3282. Also coupled to the controller3082 through the monopolar RF energy receptacle 3136 is the isolatedDC/DC converter port 3132, which receives DC power from the power bus3006, and a low bandwidth data port 3134.

The output of the third RF wideband power amplifier 3288 is fed throughan RF power transformer 3110 of a bipolar RF receptacle 3118. Bipolar RFvoltage (V) and current (I) feedback (FB) signals, which may be employedto compute RF impedance, are fed back to the controller 3082 via RF VIFB transformers 3114 through an input portion of the bipolar RF energyreceptacle 3118. The RF voltage and current feedback signals are routedback to the controller 3082 through the analog multiplexer 3280 and thedual A/D 3278. Also coupled to the controller 3082 through the bipolarRF energy receptacle 3118 is the isolated DC/DC converter port 3112,which receives DC power from the power bus 3006, and a low bandwidthdata port 3116.

A contact monitor 3290 is coupled to an NE receptacle 3292. Power is fedto the NE receptacle 3292 from the monopolar receptacle 3136.

In one aspect, with reference to FIGS. 31-37, the modular energy system3000 can be configured to detect instrument presence in a receptacle3100, 3118, 3136 via a photo-interrupter, magnetic sensor, or othernon-contact sensor integrated into the receptacle 3100, 3118, 3136. Thisapproach prevents the necessity of allocating a dedicated presence pinon the MTD connector to a single purpose and instead allowsmulti-purpose functionality for MTD signal pins 6-9 while continuouslymonitoring instrument presence.

In one aspect, with reference to FIGS. 31-37, the modules of the modularenergy system 3000 can include an optical link allowing high speedcommunication (10-50 Mb/s) across the patient isolation boundary. Thislink would carry device communications, mitigation signals (watchdog,etc.), and low bandwidth run-time data. In some aspects, the opticallink(s) will not contain real-time sampled data, which can be done onthe non-isolated side.

In one aspect, with reference to FIGS. 31-37, the modules of the modularenergy system 3000 can include a multi-function circuit block which can:(i) read presence resistor values via A/D and current source, (ii)communicate with legacy instruments via hand switch Q protocols, (iii)communicate with instruments via local bus 1-Wire protocols, and (iv)communicate with CAN FD-enabled surgical instruments. When a surgicalinstrument is properly identified by an energy generator module, therelevant pin functions and communications circuits are enabled, whilethe other unused functions are disabled and set to a high impedancestate.

In one aspect, with reference to FIGS. 31-37, the modules of the modularenergy system 3000 can include an amplifier pulse/stimulation/auxiliaryDC amplifier. This is a flexible-use amplifier based on a full-bridgeoutput and incorporates functional isolation. This allows itsdifferential output to be referenced to any output connection on theapplied part (except, in some aspects, a monopolar active electrode).The amplifier output can be either small signal linear (pulse/stim) withwaveform drive provided by a DAC or a square wave drive at moderateoutput power for DC applications such as DC motors, illumination, FETdrive, etc. The output voltage and current are sensed with functionallyisolated voltage and current feedback to provide accurate impedance andpower measurements to the FPGA. Paired with a CAN FD-enabled instrument,this output can offer motor/motion control drive, while position orvelocity feedback is provided by the CAN FD interface for closed loopcontrol.

Smart Return Pad Sensing

Aspects of the present disclosure are presented for systems and methodsfor identifying characteristics of a return pad in a monopolarelectrosurgical system using contact quality monitoring (CQM) and nearfield communication (NFC) signals. In a monopolar electrosurgicalenvironment, typically a surgical instrument having a single electrodeis applied to a surgical site of a patient. Electrosurgical energy maybe applied to the patient to conduct ablation or other kinds oftreatment, and it is critical that the energy not end at the patient,lest burns or worse may occur. A neutral electrode (NE) or non-activeelectrode, oftentimes manifested in the form of a grounding pad orreturn pad that touches the patient in a wide area, is used to draw theenergy through the patient and complete the energy path to ground. Theconnectivity of the return pad to the patient is therefore crucial. Itis regularly a concern that sensing the performance and position of thereturn pad be monitored of determined in some way, as the patient is notawake during surgery and therefore cannot provide any signal that thereis overheating or something else is wrong. It is also desired to knowthere is a problem with connectivity or other health and status ofreturn pads before burns occur, which might be the first non-aidedindication a surgeon may know that the connectivity of the return padwas faulty.

Contact Quality Monitoring generally is the process of monitoring themonopolar system to ensure it is working properly, such as by monitoringthe contact quality of the return pad. Additional information may alsobe helpful in managing the monopolar system, such as ensuring that theproper return pad is used in the surgical operation. With existingcircuitry already available for performing CQM, it may be desirable toaugment the structure to allow for more information to be obtained fromthe monopolar system.

Disclosed herein are some example systems and methods for obtainingadditional health and status information from the monopolar system usingNFC signals and CQM signals. In some aspects, resistance or impedancematerials are sensed that may help identify what kind of return pad isbeing used, including what is the structure of the pad. In some aspects,NFC signals are used to identify characteristics of the return pad. Insome aspects, the NFC signal may be transmitted in a modulated wavearrangement to communicate to a generator that is configured to supplythe electrosurgical energy in the monopolar system.

In some aspects, the grounding or return pad may include two separatematerials that form an interconnecting or interwoven mesh and both actas non-active electrodes when both contact the patient. A non-zeroimpedance may separate conductive lines connecting the two separatematerials that may be analyzed to obtain a defining signature about thatis linked to structural characteristics about the return pad. Forexample, a resistive material may be secured along the edges of the twomaterials and positioned in between them. When a signal is transmittedto the return pad, the resistive material may react and an impedancevalue may be derived from it. A CQM controller may be configured tomeasure these impedance signals of one or more return pads and maytransmit appropriate messages to the generator.

Referring to FIG. 38, shown is an example circuit diagram illustratingseveral features about a CQM controller, in accordance with at least oneaspect of the present disclosure. On the left side in solid lines isshown a CQM controller 17105, while the right side in dashed linesrepresents other components in the monopolar surgical system that itinteracts with. The right side includes a monopolar (MP) activeelectrode 17130, and two neutral electrode (NE) return pads 17135 and17140, respectively. These two NE return pads may be viewed as separatepads from an electrical standpoint, but functionally they are combinedto operate as one return pad where both touch the patient. Between thetwo NE pads 17135 and 17140 is a non-zero impedance, labeled Z_(Split).A sub-therapeutic signal passed through the two return pads 17135 and17140 may be used to obtain impedance measurements of Z_(Split) that maybe used to identify the type of pads and their structure, in accordancewith at least one aspect of the present disclosure.

Shown also is a transformer 17125 that is configured to transfer theenergy of the signals from the monopolar system over to the CQMcontroller 17105 and vice versa. The CQM controller 17105 may beconfigured to couple a CQM interrogation pulse to the NE return pads17135 and 17140 via the transformer 17125. The CQM interrogation pulsemay be a continuous signal or time domain multiplexed with othersignals. In some aspects, this drive signal may be differential orsingle ended in other cases. In some aspects, the transformer 17125 mayinclude a wide enough bandwidth to allow for multiple fundamentalfrequencies, including allowing for signals with different fundamentalfrequencies to be sent in a time domain multiplexed manner. For example,the transformer 17125 may have 1 Mhz bandwidth or below, in someaspects.

Current sense I_(SENSE) 17115 and voltage sense V_(SENSE) 17145 transmitthe signal to the A/D converter 17110, which then allow for the signalto be digitally processed by the CQM controller. In some aspects, thevoltage and current sense may be differential, while in other cases theymay be single ended. In some aspects, a redundant current senseI_(sense2) 17120 is included to ensure proper functioning to mitigatecomponent failures of important circuitry. A redundant voltage sense mayalso be included, not shown. These may allow for the voltage and currentmeasurements obtained from Z_(Split) to be digitized via the A/Dconverter 17110. In this way, additional processing may be performed toobtain cleaner signals and help ensure that the return pad isappropriately in contact with the patient and functioning properly,generally. As some examples, digital filtering may then be performed,frequency-domain analysis can be performed, and the digitized signal mayallow for signal demodulation and data recovery. Performing digitalsignal processing on the converted digitized signal may help preventnuisance alarms, for example, as the noise in the signal may be filteredout in this way.

Referring to FIG. 39, shown is an example design layout of a return padconfigured to facilitate its identification using a pre-configurednon-zero impedance, in accordance with at least one aspect of thepresent disclosure. As shown, and unlike typical return pads, the returnpad 17200 now includes two unique mesh portions 17205 and 17210,illustrated by orthogonal diagonal lines in FIG. 39. Each portion isitself a neutral or non-active electrode, and may be made of similarmaterials used to make traditional grounding pads, noting that they aretwo separate portions that do not directly contact one another. Asshown, the two mesh portions 17205 and 17210 form a split-plate padscheme, with interlocking or interweaving structures that stretchthrough most of the overall return pad 17200. This allows for both ofthe portions 17205 and 17210 to touch substantially the same areas ofthe patient. The two pieces 17205 and 17210 are connected to separate NEconductive return lines 17225 and 17230, respectively, both of which areconnected to a single discrete resistor in the body of a connector17220. A resistance material or medium 17215 is present between the twomesh portions 17205 and 17210 and is directly connected to both of them.

The conductive lines 17225 and 17230 may be separated by a non-zeroimpedance, which is measured by the energy generator 17235 that suppliesenergy through the monopolar surgical system. The non-zero impedance mayinclude the discrete resistor in the body of the connector 17220, or theresistive material 17215. As shown, the conductive lines 17225 and 17230are connected to the NEs 17205 and 17210, which are physically separatedby the resistive material 17215, and therefore the conductive lines arealso separated by the resistive material 17215. In some aspects, thematerial 17215 in between the NEs 17205 and 17210 may be a dielectricmaterial that produces a complex impedance, supplying both a phase andan impedance. An impedance measurement may be obtained that may uniquelydefine what type of return pad is being used in the operation, forexample, by installing a particular amount of resistive material 17215or installing a different type of material 17215 that has apredetermined amount of impedance. Using the monitoring methodologydescribed in FIG. 38 to obtain an impedance measurement, the CQMcontroller may thus be able to identify the type of pad and thestructure of the pad. In some aspects, the resistive medium 17215 mayprovide a particular amount of impedance when measured, based on the waythe return pad is constructed and what it is used for. Some return padsmay need to provide a higher amount of impedance given their function,and this difference may be reflected in the impedance measurementsdetermined at the resistive medium 17215.

Referring to FIG. 40, shown is a block diagram with structures similarto FIG. 38 that also include means for identifying the return pad usingNFC signals, in accordance with at least one aspect of the presentdisclosure. Shown here is the energy generator 17250, that includes aCQM controller 17255 and a demodulation module 17265. The signals to andfrom the energy generator may pass through the transformer 17270,similar to the transformer in FIG. 38. This is communicatively coupledto the return pad 17260.

In the return pad 17260, electrode 1 17272 and electrode 2 17285 may belike the neutral electrodes 17205 and 17210 in FIG. 39, and NEs 17135and 17140 in FIG. 38. The impedance Z_(Split) 17280 represents thenon-zero impedance separating the electrodes 17275 and 17285, like thenon-zero impedance described in FIG. 39. Here, the return pad 17260 alsoincludes an NFC tag 17300 that may be embedded into the return pad 17260without any additional circuitry required. It may be attached to avoltage clamp 17295 and an existing bandpass filter 17290.

The NFC tag may provide a second way to identify the return pad, inaccordance with at least one aspect of the present disclosure. The CQMcontroller 17255 may generate an NFC carrier wave at a frequencysuitable for the NFC tag 17300. In some aspects, the NFC carrier wavemay be time-domain multiplexed with the CQM interrogation pulse, so thatthe CQM controller may continue to perform its main function of contactquality monitoring. In some aspects, the NFC tag may require anon-standard frequency in order to access the information. The NFC tag17300 may modulate the carrier wave to transmit identification datacontained in the NFC tag. This may be transmitted back to the energygenerator 17250. The signal may then be demodulated at the demodulationmodule 17265 and the data may be received. The band pass filter 17290may be used to isolate the CQM interrogation pulse from the NFC carrierwave when both are transmitted in a modulated signal, described more inFIG. 41 as an example. During this process, the voltage clamp 17295 mayprotect the NFC tag from any excessive voltage during monopolar energydelivery. The position of the filter and the voltage clamp may be suchthat monopolar return current from the neutral electrodes 17275 and17285 may be unimpeded when flowing back to the energy generator.

Referring to FIG. 41, shown is an example of how two signals may becombined to be processed by the CQM controller, in accordance with atleast one aspect of the present disclosure. Shown here is an examplecarrier wave 17310 that may represent the NFC signal, while the messagewave 17320 represents the CQM interrogation signal. These may becombined into an amplitude modulated wave 17330 that contains the properimpedance information transmitted as an NFC signal. As discussed above,this signal may then be filtered by the band pass filter 17290 toregister with the NFC tag 17300, and upon return to the energygenerator, the modulated signal may be demodulated at the demodulationmodule 17265 to obtain the identifying information supplied by the NFCtag. The interrogation pulse is still present in the modulated signal,and may be filtered out at a different stage to perform the normalcontact quality monitoring. It may be seen now that designing returnpads to produce a particular impedance measurement that can be uniquelyspecific to each type of pad, and then transmitted using NFC, canprovide additional information about the return pad while still allowingfor proper contact quality monitoring.

Referring to FIG. 42, chart 17400 provides an example designation oftypes of return pads that may be categorized based on differentimpedance measurements, in accordance with at least one aspect of thepresent disclosure. As shown, the impedance measurements for each typeof pad do not overlap with each other, allowing for a uniqueidentification. These impedance measurements may be specified andmanufactured for each return pad such that the readings may be obtainedproperly by a CQM controller. The resistive material, or the non-zeroimpedance generally as discussed in FIG. 39, may be built ormanufactured into each type of return pad to produce this amount ofimpedance in each system. For example, a thinner amount of resistivematerial may be used, and/or different materials that produce the rangeof impedance may be placed in particular devices as opposed to others.Thus, when employing the identification methods described in FIGS. 38and 39, the impedance readings in the left column of chart 17400 will beobtained, which will correspond to the type of return pad as describedin the middle column.

In some aspects, in addition or alternatively, the NFC tag embedded intothe return pad and as described in FIG. 40 may similarly be used toprovide the same kind of identifying information. The measure ofimpedance may not need to be provided, but instead other uniquelyidentifying information may be provided by the NFC tag to signal to theCQM controller what type of return pad is being monitored, according tothe description in the middle column of chart 17400, for example. Insome aspects, the NFC tag may also provide other characteristicinformation about the return pad, such as thickness of the pad, specinformation, date of manufacture, and so forth.

Referring to FIG. 43, shown is an example time series of a messagechannel used for time-domain multiplexing the different types of signalsbetween the energy generator and the return pad, in accordance with atleast one aspect of the present disclosure. Here, the time-domainmultiplexing schedule is divided into three sections that repeat. TheCQM interrogation pulse 17450 may be transmitted first, then time may begiven for an NFC frame 17460 to be received, and then some period ofidle time 17470 may separate the next period. In some cases, the amountof time for each of these sections may not be the same, as there may bemore idle time 17470, for example, or the length of time needed for theNFC frame 17460 may be longer than the CQM interrogation pulse 17450, orthe pulse may need to be wider.

In some aspects, situational awareness may be employed to learn andadapt to the different impedance readings of various grounding pads. Forexample, the initial impedance measurements received by the CQM devicemay lead a hub having situational awareness to acknowledge and identifywhat type of grounding pad is present. Once this is determined, the hubmay be configured to tabulate the performance and outcomes of thesurgical procedure and tie it to the type of grounding pad that wasused. Any inadvertent burns or other performance characteristics aboutthe grounding pad may be correlated to the type of surgical procedurethat occurred. A cloud system in communication with multiple hubs maystore dozens or hundreds of these types of data points and developpatterns that can be used to gauge the performance of grounding pads inthe context of the surgical procedures they are used in. By comparingthe performance of the return pads in the same type of procedure toother types of return pads, it may be possible to determine how best toutilize the return pads or see where there are flaws or vulnerabilities,as some examples.

Furthermore, situational awareness may be applied to the type ofmonopolar devices used, or the amount of energy supplied in combinationwith the surgical procedure and the grounding pad used. Using similarmethods for tabulating data, a cloud system may be able to find patternsin how grounding pads may interact with the overall surgical system theyare used in, if any patterns arise. This can also include measurementsover time and any spikes in energy, and in the context in which thosespikes might arise.

If there are any faults or burns that occur that the grounding pad couldnot effectively handle, patterns may be devised to see if there are anyunique precursors that might suggest these faults are about to occur.Warning signals could then be developed and applied to the system.Similarly, if the grounding pad consistently reacts poorly after someevent, patterns around any uniquely identifying data may be developedand warning signals could be applied to the system.

EXAMPLES

Various aspects of the subject matter described herein are set out inthe following numbered examples:

Example 1

A grounding pad for use in a monopolar surgical system, comprising: afirst non-active electrode; a second non-active electrode; a firstconductive line electrically coupled to the first non-active electrode;a second conductive line electrically coupled to the second non-activeelectrode; and a non-zero impedance separating the first conductive linefrom the second conductive line; wherein the non-zero impedance providesan impedance measurement that provides defining information about whattype of pad is the grounding pad.

Example 2

The grounding pad of example 1, wherein the first non-active electrodecomprises a first plurality of elongated members, and the secondnon-active electrode comprises a second plurality of elongated members.

Example 3

The grounding pad of example 2, wherein the first plurality of elongatedmembers interweave with the second plurality of elongated members.

Example 4

The grounding pad of example 3, wherein the non-zero impedance comprisesa resistive material that is coupled in between the interwoven first andsecond plurality of elongated members.

Example 5

The ground pad of example 3, wherein the interwoven first and secondplurality of elongated members form a substantially planar surfaceproviding a surface area on one side configured to make contact with apatient.

Example 6

The grounding pad of any one of examples 1 to 5, further comprising aconnector coupled to both the first conductive line and the secondconductive line, and wherein the non-zero impedance comprises a resistorin the connector.

Example 7

The grounding pad of any one of examples 1 to 5, further comprising apower source coupled to the first and second return lines and configuredto transmit a signal to the first and second non-active electrodessimultaneously via the first and second conductive lines.

Example 8

The grounding pad of example 7, wherein the non-zero impedance isfurther configured to generate an impedance measurement in response tothe transmitted signal transmitted to both the first and secondnon-active electrodes.

Example 9

The grounding pad of any one of examples 3 to 8, wherein the non-zerocomprises a dielectric material that is coupled in between theinterwoven first and second plurality of elongated members, and whereinthe dielectric material is configured to produce a complex impedancecomprising a non-zero phase in addition to the non-zero impedance.

Example 10

The grounding pad of any one of examples 1 to 9, wherein the signalcomprises a carrier wave component and a message wave component that arecombined to form an amplitude modulated wave that is configured to bereceived by a contact quality monitoring device.

Example 11

The grounding pad of any one of examples 1 to 10, wherein thenon-impedance measurement is a predefined measurement configured toidentify one or more functional characteristics of the grounding pad.

Example 12

The grounding pad of any one of examples 1 to 11, further comprising anear field communication (NFC) tag configured to provide identifyinginformation about the grounding pad when probed by a contact qualitymonitoring (CQM) module.

Example 13

The grounding pad of example 12, configured to respond to both a CQMinterrogation pulse and an NFC carrier wave signal according to a timedomain multiplexed schedule.

Example 14

A method for identifying a grounding pad, the grounding pad comprising afirst non-active electrode and a second non-active electrode, the methodcomprising: transmitting, by a control circuit, a signal to both thefirst non-active electrode and the second non-active electrode;generating, by a non-zero impedance coupled to both the first non-activeelectrode and the second non-active electrode, an impedance measurementin response to the transmitted signal; and transmitting the impedance bya transformer using a modulated signal.

Example 15

The method of example 14, wherein the first non-active electrodecomprises a first plurality of elongated members, and the secondnon-active electrode comprises a second plurality of elongated members.

Example 16

The method of example 15, wherein the first plurality of elongatedmembers interweave with the second plurality of elongated members.

Example 17

The method of example 16, wherein the non-zero impedance comprises aresistive material that is coupled in between the interwoven first andsecond plurality of elongated members.

Example 18

The method of example 16, wherein the interwoven first and secondplurality of elongated members form a substantially planar surfaceproviding a surface area on one side configured to entirely make contactwith a patient.

Example 19

The method of example 18, wherein the carrier wave component and themessage wave component are combined to form an amplitude modulated wavethat is configured to be received by a contact quality monitoringdevice.

Example 20

A monopolar surgical system, comprising: a generator; a monopolarsurgical instrument comprising an electrode configured to deliverelectrosurgical energy to a patient; a grounding pad comprising: a firstnon-active electrode; a second non-active electrode; a first conductiveline electrically coupled to the first non-active electrode; a secondconductive line electrically coupled to the second non-active electrode;a non-zero impedance separating the first conductive line from thesecond conductive line; wherein the non-zero impedance provides animpedance measurement that provides defining information about what typeof pad is the grounding pad; and a contact quality monitoring deviceconfigured to perform contact quality monitoring on the grounding padand also receive the impedance measurement to identify what type of padis the grounding pad.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

1. A grounding pad for use in a monopolar surgical system, comprising: afirst non-active electrode; a second non-active electrode; a firstconductive line electrically coupled to the first non-active electrode;a second conductive line electrically coupled to the second non-activeelectrode; and a non-zero impedance separating the first conductive linefrom the second conductive line; wherein the non-zero impedance providesan impedance measurement that provides defining information about whattype of pad is the grounding pad.
 2. The grounding pad of claim 1,wherein the first non-active electrode comprises a first plurality ofelongated members, and the second non-active electrode comprises asecond plurality of elongated members.
 3. The grounding pad of claim 2,wherein the first plurality of elongated members interweave with thesecond plurality of elongated members.
 4. The grounding pad of claim 3,wherein the non-zero impedance comprises a resistive material that iscoupled in between the interwoven first and second plurality ofelongated members.
 5. The grounding pad of claim 3, wherein theinterwoven first and second plurality of elongated members form asubstantially planar surface providing a surface area on one sideconfigured to make contact with a patient.
 6. The grounding pad of claim1, further comprising a connector coupled to both the first conductiveline and the second conductive line, and wherein the non-zero impedancecomprises a resistor in the connector.
 7. The grounding pad of claim 1,further comprising a power source coupled to the first and second returnlines and configured to transmit a signal to the first and secondnon-active electrodes simultaneously via the first and second conductivelines.
 8. The grounding pad of claim 7, wherein the non-zero impedanceis further configured to generate an impedance measurement in responseto the transmitted signal transmitted to both the first and secondnon-active electrodes.
 9. The grounding pad of claim 3, wherein thenon-zero comprises a dielectric material that is coupled in between theinterwoven first and second plurality of elongated members, and whereinthe dielectric material is configured to produce a complex impedancecomprising a non-zero phase in addition to the non-zero impedance. 10.The grounding pad of claim 1, wherein the signal comprises a carrierwave component and a message wave component that are combined to form anamplitude modulated wave that is configured to be received by a contactquality monitoring device.
 11. The grounding pad of claim 1, wherein thenon-impedance measurement is a predefined measurement configured toidentify one or more functional characteristics of the grounding pad.12. The grounding pad of claim 1, further comprising a near fieldcommunication (NFC) tag configured to provide identifying informationabout the grounding pad when probed by a contact quality monitoring(CQM) module.
 13. The grounding pad of claim 12, configured to respondto both a CQM interrogation pulse and an NFC carrier wave signalaccording to a time domain multiplexed schedule.
 14. A method foridentifying a grounding pad, the grounding pad comprising a firstnon-active electrode and a second non-active electrode, the methodcomprising: transmitting, by a control circuit, a signal to both thefirst non-active electrode and the second non-active electrode;generating, by a non-zero impedance coupled to both the first non-activeelectrode and the second non-active electrode, an impedance measurementin response to the transmitted signal; and transmitting the impedance bya transformer using a modulated signal.
 15. The method of claim 14,wherein the first non-active electrode comprises a first plurality ofelongated members, and the second non-active electrode comprises asecond plurality of elongated members.
 16. The method of claim 15,wherein the first plurality of elongated members interweave with thesecond plurality of elongated members.
 17. The method of claim 16,wherein the non-zero impedance comprises a resistive material that iscoupled in between the interwoven first and second plurality ofelongated members.
 18. The method of claim 16, wherein the interwovenfirst and second plurality of elongated members form a substantiallyplanar surface providing a surface area on one side configured toentirely make contact with a patient.
 19. The method of claim 18,wherein the carrier wave component and the message wave component arecombined to form an amplitude modulated wave that is configured to bereceived by a contact quality monitoring device.
 20. A monopolarsurgical system, comprising: a generator; a monopolar surgicalinstrument comprising an electrode configured to deliver electrosurgicalenergy to a patient; a grounding pad comprising: a first non-activeelectrode; a second non-active electrode; a first conductive lineelectrically coupled to the first non-active electrode; a secondconductive line electrically coupled to the second non-active electrode;a non-zero impedance separating the first conductive line from thesecond conductive line; wherein the non-zero impedance provides animpedance measurement that provides defining information about what typeof pad is the grounding pad; and a contact quality monitoring deviceconfigured to perform contact quality monitoring on the grounding padand also receive the impedance measurement to identify what type of padis the grounding pad.